(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The American journal of the medical sciences"


^ 


















THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES, 



No. XVII.— Nov. 1831. 1 



COLLABORATORS. 



Jacob Bigjelow, M. D. Professor of 
Materia Medica in Harvard Univer- 
sity, Boston. 
Edward H. Bartoi^, M. D. of St. 
Francisville, Louisiana. 

Walter Changing, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard university, Boston, 

N. Chapmak, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

JoHif REDMAif CoxE, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 

Wiiliam: C. Daniei.1, M. D. of Savan- 
nah, Georgia. 

WiiiiiAM P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 

S. Hekrt DicKsoisr, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of S. Carolina. 

C. Drake, M. D. of New York. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

GoirvERNETjR Emerson, M. D. of Phila- 
delphia. 

Thomas Fearn, M. D. of Alabama. 

John W. Francis, M. D. Professor 
of Obstetrics and Forensic Medicine 
in Rutgers Medical College, N. York. 

E. Geddings, M. D. Lecturer on Anato- 
my and Surgery, Ckarlestoti, South 
Carolina. 

William Gibson, M. D. Professor of 
Surgery in the tiniversity of Pennsyl- 
vania. 

R. E. Griffith, M.D. Lecturer on Ma- 
teria Medica and Pharmacy in the 
Philadelphia School of Medicine. 

E. Hale, M. D. of Boston. 

Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 

Isaac Hats, M. D. one of the Surgeons 
of the Pennsylvania Infirmary for 
diseases of the Eye and Ear. 

George Haxward, M. D. of Boston. 

Thomas Henderson, M. D. Professor 
of the Theory and Practice of Medi- 



cine in the Columbian College, Bls" 
irict of Columbia. 

William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer- 
sity of Pennsylvania. 

David Ho sack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Rutgers Medical College, New York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

C. B. Matthews, M. D. 0/ Philadel- 
phia. 

Valentine Mott, M. D. Professor of 
Pathological and Operative Surgery 
i?i the College of Physicians and Sur- 
geons, New York. 

James Moultrie, Jr. M. D. of Charles- 
ton, S. C. 

Reuben D. Musset, M. D. Professor 
of Anoiomy and Surgery in Dart- 
mouth College, New Hampshire. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Stng Phtstck, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. D. Professor of 
the Theory and Practice of Medicine 
in the University of Maryland. 

D. L. Rogers, M. D. of New York. 
Thomas Sewall, M. D. Professor of 

Anatomy and Physiology in the Co- 
lumbian College, District of Colum- 
bia. 

A. F. Vache, M. D. ofNetu York. 

John Ware, M. D. of Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, Philadelphia. 

N. W. Worthington, M. D. Professor 
of Materia Medica in the Columbian 
College, District of Columbia. 

Thomas H. Wright, M. D. Physician to 
the Baltimore Aims-House Infirmary, 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



VOL. IX. 



PHILADELPHIA: 
CAREY & liEA 

1831. 



Med. 



TO READERS AND CORRESPONDENTS, 



Communications have been received from Drs. Heustis, Williams, Bboocks, 
and Moore. 

In compliance with the request of the Prize Essay Committee of the Medico- 
Chirurgical Faculty of Maryland, we inserted in our last No. the Prize Essay of 
Dr. Caldwell; we are happy again to meet their wishes by stating-, that there 
was an introduction and an appendix to the essay, neither of which appear in 
the Journal. 

We have received the following" works: — 
- Traits Complet de Physiologie de I'Homme. Par Fbed. Tiedemann, Pro- 
fesseur de Physiologie a I'University de Heidelberg. Traduit de I'Allemand. Par 
A. J. L., JoTJiiDATf, D. M. p. Part I. and II. J. B. BailHere, Paris, 1831. (From 
the publisher.) 

Physiologie Medicale et Philosophique. Par Alm. Lepelletiek, de la 
Sarthe. Tom. I. Germer Bailliere, Paris, 1831. (From the publisher.) 

Address delivered before the Medical Society of the city and county of New 
York, on the 25th day of July, 1831. By Daniel L. M. Peixotto, M. D. Pre- 
sident. New York, 1831. (From the author.) 

Remarks on the History and Treatment of Delirium Tremens. By John- 
Wake, M. D. Member of the Massachusetts Medical Society. (From the author.) 

Medico-Chirurgical Transactions. Vol. XVI. Part II. (From the Society.) 

Descriptio Ichthyosis Corneae Congenitse in Virgine Observatse, tabulis tri- 

bus lapidi incisis illustrata. Auctor Chr. Helv. Schmidt, M. D. (From Dr. 

Von DEM BUSCH.) 

We are also indebted to our valued correspondent. Dr. Von dem Busch, of 
Bremen, for the following Inaugural Dissertations. 

De Secali Cornuto ejusque vi in Corpus Humanum salubri et inimica. 
Auctor C. S. Haese. 

Qusedam de Prsecipuis Morbis qui post operationem cataractae oriri possunt, 
Auctor G. A. Closset. 

De Morborum Psychicorum Curatione Generaliora Qusedam. Auctor F. A. 
Meter. 

De Angina Membranacea. Auctor G. Zickner. 

De Sana et Morbosa Pinguedinis in corpore secretione. Auctor G. C. Gritne. 

De Ovariorum Degeneratione. Auctor H. J. G. Beck. 

Chemical Manipulation, being Instructions to Students in Chemistry, on the 
Methods of performing experiments of Demonstration or of Research, with ac- 
curacy and success. By Michael Faraday, F. R. S., M. R. I. &c. &c. First 
American, from the last London edition, edited by J. K. Mitchbll, M. D. 

1* 



6 TO READERS AND CORRESPONDENTS. 

Lecturer on Medical Chemistry in the Philadelphia Medical Institute. Philadel- 
phia, Carey & Lea, 1831. (From the pubUshers.) 

Essays on some of the most important articles of the Materia Medica, &c. &c. 
By G. W. Cabpewter. Philadelphia, 1831. (From the author.) 

On Baths and Mineral Waters. In two parts. Part I. A full account of the 
Hygienic and Curative Powers of cold, tepid, hot, and vapour baths, and sea 
bathing-. Part II. A History of the Chemical Composition and Medicinal Pro- 
perties of the chief Mineral Springs of the United States and Europe. By 
JoHif Beli, Lecturer on the Institutes of Medicine and Medical Jurisprudence, 
Member of the Medical and Kappa Lambda Societies, and Fellow of the Col- 
lege of Physicians, Philadelphia, and of the Georgofoli Society of Florence, &c. 
Philadelphia, 1831. (From the author.) 

Annales de la Medecine Physiologique, February, March, April, May, 1831. 
(In exchange.) 

Archives Generales de Medecine, April, May, June, July, 1831. (In ex- 
change.) 

Revue Medicale, April, May, June, July, 1831. (In exchange.) 

Journal Universel et Hebdomadaire, April, May, June, July, August, 1831. 
(In exchange.) 

Gazette Medicale, April, May, June, July, August, 1831. (In exchange.) • 

Journal de 'Chimie Medicale, March, April, May, June, July, August, 1831. 
(In exchange.) 

Bulletin des Sciences Medicales, January, 1831. (In exchange.) 

Transactions Medicales, May, June, July, 1831. (In exchange.) 

Journal der Chirurgie und Augen-Heilkunde. Herausgegeben Von C. F. 
V. Gbaefe and Ph. V. Walthek. Band XIV. Heft 3. (In exchange.) 

The London Medical Gazette, May, June, July, August, 1831. (In exchange.) 

The London Medical and Physical Journal, June, July, August, 1831. (In 
exchange. ) 

London Medical and Surgical Journal, May, June, July, 1831. (In exchange.) 
The Glasgow Medical Journal, May, 1831. (In exchange.) 
The Midland Medical and Surgical Reporter, May, 1831. (In exchange.) 
The Medico-Chirurgical Review, July, 1831. (In exchange.) 
The Edinburgh Medical and Surgical Journal, July, 1831. (In exchange.) 
The North of England Medical and Surgical Journal, June, 1831. (In ex- 
change.) 

The Western Journal of the Medical and Physical Sciences, July 1831. (In 
exchange.) 

The Transylvania Journal of Medicine and the Associate Sciences, July, Oc- 
tober, 1831. 

New York Medico-Chirurgical Bulletin, edited by George Bushe, M. D. 
May, June, July, August, September, 1831. (In exchange.) 
The New York Medical Journal, August, 1831. (In exchange.) 



TO READERS AND CORRESPONDENTS. 7 

For the gratification of our contributors we present references to the works 
received during the last three months, in which their communications are no- 
ticed. 

Professor Mott will find his case of Axillary Aneurism noticed in the London 
Medical and Physical Journal, for June, and the London Medical and Surgical 
Journal, for June, 1831; and his case of Aneurism of the Arteria Innominata, 
in the Glasgow Medical Journal, for May, 1831. 

Professor Gibson's case of Axillary Aneurism, is noticed in the Glasgow Me- 
dical Journal, for May, 1831. 

Professor Hendehson's cases of Phthisis are copied into the Boston Medical 
and Surgical Journal, for October 4th, and into the New York Medical Journal, 
for August, 1831. 

Professor Parson's Memoir on Animal and Vegetable Malaria, is noticed in 
the Lancet, for June, 1831. 

Dr. Barton's case of Longitudinal Section of the Lower Jaw, is noticed in 
the New York Medical and Chirurgical Bulletin, for July, 1831. 

Dr. Wright's Case of Tubero-Carunculoid Liver, is copied into the London 
Medical and Surgical Journal, for June, 1831. 

Dr. Randolph's Memoir on Morbus Coxarius, is noticed in the London Me- 
dical and Surgical Journal, for June, 1831. 

Professor Geddings' Essay on the Use of Strychnine in Paralysis, is noticed 
in the London Medical and Surgical Journal, for May, 1831. 

Dr. Mitchell's New Practice in Rheumatism, is noticed in the Transylvania 
Journal, No. XIV. and in the New York Medico-Chirurgical Bulletin; his ex- 
periments on Endosmose and Exosmose, are copied into the Journal of the 
Royal Institution, No. IV. and V. and are noticed in the Edinburgh Medical 
and Surgical Journal, for July; his case of Gonorrhsea, caused by the Lochial 
Discharge, is noticed in the London Medical and Physical Journal, for June. 

Dr. Fahnestock's Observations on the Utility of the Compound Tincture of 
Benzoin in Burns, are noticed in the Revue Medicale, for May, 1831. 

Dr. Faust's Experiments on Endosmose and Exosmose, are noticed in the 
Edinburgh Medical and Surgical Journal, for July, and in the Journal de Chi- 
mie Medicale, for March, 1831. 

Dr. Bellinger's Remarks on the Use of Ergot in Menorrhagia, are copied 
into the London Medical and Surgical Journal, for May, 1831. 

Dr. Howe's Operation for Hair Lip, is noticed in the Western Journal of the 
Medical and Physical Sciences, for July, 1831. 

Dr. Callaghan's Account of Scarlatina Anginosa, is noticed in the New York 
Medico-Chirurgical Bulletin, for June, 1831. 

Dr. Young's Remarks on Cancrum Oris, are noticed in the New York Medico- 
Chirurgical Bulletin, for June, 1831. 

Dr. Ruan's Case of Elephantiasis of the Scrotum, is noticed in the Revue 
Medicale, for May, 1831. 



8 TO READERS AND CORRESPONDENTS. 

Dr. HoRT*s Case of Poisoning with Corrosive Sublimate, is noticed in the Re- 
vue M^dicale for May, and in the Archives Generales, for April, 1831. 

Dr. Vaughan's Cases are noticed in the Transylvania Journal, No. XIV., and 
in the New York Medico-Chirurgical Bulletin, for June, 1831. 

Dr. Riviifus's Memoir on the Operation of Physical Causes in Man, is no- 
ticed in the London Medical and Surgical Journal, for June, 1831. 

Mr. Carpenter's Account of Maracaibo Bark, is noticed in the London Me- 
dical and Surgical Journal, for June, 1831. 

Authors of new medical books, desirious of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editor 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused by 
the circuitous routes through which they are received. 

Papers intended for publication, should be sent,/ree of expense^ as early after 
the appearance of the Journal as possible, in order to be in time for the ensuing 
number. Such communications should be addressed to "Caret & Lea, Phila- 
delphia, for the Editor of the American Journal of the Medical Sciences," or 
may be deposited with Professor J. C. Warren, M. D. Boston — C. Drajce, 
M. D. New York, or Professor S. H. Dickson, M. D. Charleston, S. C. 

All letters on the business of the Journal to be addressed exclusively to the 
publishers. 



CONTENTS 



ORIGINAL COMMUNICATIONS. 

ESSAYS. 

Art. Page. 

I. Medical Statistics; consisting" of estimates relating to the Population of 
Philadelphia, and its changes as influenced by the Deaths and Births dur- 
ing a period of ten years, viz. from 1821 to 1830 inclusive. By G. 
Emerson, M. D. 17 

II. Case of Immobility of the Jaw and Taliacotion Operation. By Valentine 
Mott, M. D. &c. &c. [With a Plate.] 47 

III. Case of Imraobihty of the Jaw, successfully treated by Professor Mott's 
Complicated Lever, and a Modification of his Operation. By Jesse W. 
Mighels, M. D. of Maine 50 

IV. On the Adaptive Powers of the Eye. By H. Morton, M. D. of New 
York 51 

V. Cases of Cutaneous Diseases, with Pathological and Practical Remarks. 

By Dr. Mllo L. North, of Hartford, Conn 66 

VI. On the Use of Conium Maculatum in Afiections of the Female Breast, 
and in Cancerous Ulcerations. By Stephen W. Williams, M. D. late 
Professor of Medical Jurisprudence in the Berkshire Medical Institution 77 

VII. Reports of Cases treated at the Baltimore Alms-house Infirmary. By 
Thomas H. Wright, Physician to the Institution - - - - 81 

VIII. Case of Traumatic Tetanus, successfully treated. By Antrim Foulke, 

M. D. of Montgomery County, Penn. -.-,.. 100 

IX. Observations on the Modus Medendi of Emetics. By Robert J. Turn- 
bull, M. D. of Charleston, S. C. 101 

X. Report of the Committee of the Board of Health of Charleston, respect- 
ing the Prevalence of Varioloid and Small-pox in that city during the 
year 1829 - 116 

REVIEW. 

XI. Observations on the Structure and Diseases of the Testis. By Sir 
Astley Cooper, Bart., F. R. S., &c. pp. 245, large quarto, with plates. 
London, 1830 128 

BIBLIOGRAPHICAL NOTICES. 

XII. History of Chronic Phlegmasia;, or Inflammations, founded on Clinical 
Experience and Pathological Anatomy, exhibiting a view of the diff'erent 
varieties and complications of these Diseases, with their various Methods 
of Treatment. By F. J. V. Broussais, M. D. Knight of the Royal Order 
of the Legion of Honour, Physician-in-Chief and First Professor in the 
Military Hospital of Instruction of Paris, Member of the Royal Academy 



10 CONTENTS. 

Page. 

of Medicine, of the Royal Medical Society of Madrid, of the Patriotic 
Society of Cordova, Corresponding Member of the Society of Emulation 
of Liege, of the Medical Societies of Philadelphia, New Orleans, and 
Louvain, &c. &c. Translated from the French of the Fourth Edition, 
by Isaac Hays, M. D. and R. Eglesfeld Griffith, M. D. Members of the 
American Philosophical Society, of the Academy of Natural Sciences, 
Honorary Members of the Philadelphia Medical Society, &c. &c. Phila- 
delphia, Carey & Lea, 8vo. Vol. L pp. 497? Vol. H. pp. 404 - - 135 

Xni. Descriptio Ichthyosis Cornese Congenitse in Virgine observatae, tabulis 
tribus lapidi incisis illustrata. Bremse. Chr. Helv. Schmidt, M. D. 

Description of a Case of Congenital Ichthyosis Cornese, observed in a young 
Girl; with three Lithographic Plates. By Chr. Helv. Schmidt, M. D. 
Folio, pp. 15. Bremen, 1830 138 

XIV. Directions for making Anatomical Preparations, formed on the basis 
of Pole, Marjohn, and Breschet; and including the New Method of Mr. 
Swan. By Usher Parsons, M. D. Professor of Anatomy and Surgery. 
Philadelphia, Carey 8c Lea, 1831 143 

XV. A Manual of Medical Jurisprudence, compiled from the best medical 
and legal Works, comprising an account, 1st, Of the Ethics of the Medi- 
cal Profession; 2d, The Charters and Statutes relating to the Faculty; 
and 3d, All medico-legal Questions, with the latest decisions; being an 
Analysis of a course of Lectures on Forensic Medicine, annually delivered 
in London, &c. &c. By Michael Ryan, M. D. &c. &c. London, 1831, 
pp. 309, 8vo. 146 

XVI. Medico-Chirurgical Transactions. Vol. XVL PartIL London, 1831, 
pp. 236, 8vo. 149 

XVII. A Treatise on Indigestion, with Observations on some painful com- 
plaints originating in Indigestion, as Tic Doloureux, Nervous Disorder, 
&c. By Thomas J. Graham, of the University of Glasgow, and of the 
Royal College of Surgeons, London, 8cc. First American, from the last 
London edition, revised and enlarged, with Notes and an Appendix, con- 
taining Observations relative to the Modes of treating Dyspepsia, lately 
adopted and recommended by Dr. Avery, Mr. Halstead, and others. By 

an American Physician. Philadelphia, Key & Mielke. Oct. pp. 206 - 163 

XVIII. Remarks on the History and Treatment of Delirium Tremens. By 
John Ware, M. D. Fellow of the Massachusetts Medical Society. Boston, 
1831, pp. 61, 8vo. 164 

XIX. Treatise on the Excision of Diseased Joints. By James Syme, Sur- 
geon, &c. p. 163, 6vo. Plates V. Edinburgh, 1831 - - - 168 

XX. Practical Observations on Prolapsus of the Rectum. By Frederick 
Salmon, F. R. C. S. 8cc. &c. London, 1831. pp. 105, 8vo. Plates IV. 174 

XXI. An Essay on the use of Nitrate of Silver, in the cure of Inflamma- 
tions, Wounds, and Ulcers. By John Higginbottom, Nottingham, Mem- 
ber of the Royal College of Surgeons of London. Second edition, much 
improved and enlarged. London, 1829, pp. 204, 8vo. - - - 177 

XXII. A Manual of Materia Medica and Pharmacy, comprising a Concise 
Description of the Articles used in Medicine; with Observations on the 



CONTENTS. 



11 



Page. 
Proper Mode of Combining and Administering- them; Also the Formula 
for the Officinal Preparations of the London, Edinburg-h, Dublin, Parisian, 
American, and most of the Continental Pharmacopoeias; tog-ether with a 
Table of the Principal Medicinal Plants. From the French of H. M. 
Edwards, M. D. and P. Vavasseur, M. D. Corrected and Adapted to 
British Practice. By John Davies, M. R. C. S. Surgeon of the Hert's 
Militia; late Editor of the London Medical and Surgical Journal, &c. pp. 
490, 8vo. London, 1831 185 



QUARTERLY PERISCOPE 

FOREIGN INTELLIGENCE. 
Anatomt. 



Page. 

1. Anomalies in the Arterial Sys- 
tem and in the Ganghonary 
Nervous System. By M. Jodin 187 

2. On the Perspiratory Vessels of 
the Skin. By Dr. Hake - 188 

3. Malformation of the Uterus. By 

M. Vidal ... - 190 



Page. 

4. Anomalous Arrangement of the 
Aorta. By M. Cruveilhier and 

M. Berard,' Jr. - - - 190 

5. Anomaly in the Pneumogastric 
Nerves. By M. Bignardi - ib. 



Phtsiologt. 



. Mechanism of the Human Voice 
during Singing. By M. Bennati 191 
On the Connexion between the 
Maternal Vessels and Cord. By 
S. C. Holland, M. D. . - 192 

. Case of complete absence of 
the Cerebellum, together with 
Posterior Peduncles and Protu- 
berances of the Cerebrum, in a 
young girl who died in her ele- 
A'-enth year. By M. Combette 193 

, Extraordinary Case of Dis- 
charge of Oil from the Bowels, 



and Sugar from the Urinary Pas- 
sages, By Dr. Elliotson - 195 

10. Influence of the Genital Or- 
gans on the Cerebellum. By 
Baron Larrey - - - 196 

11. Atrophy of one-half of the En- 
cephalon. By M. Bodey - 197 

12. Function of the Optic and Ol- 
factory Nerves. By M. Vidal ih. 

13. On Extra-Uterine Fcetation. 

By Professor Chaussier - 198 

14. Pulsation in the whole Vascu- 
lar System. By Dr. David Bad- 
ham ib. 



Pathologt. 



15. Remarkable Instance of He- 
morrhagic Tendency in a Fa- 
mily. By Dr. Riecken - 199 

16. Case of General Emphysema 
produced by Combustible Gas. 

By M. Bally ... 202 

17. On the Respective Prevalence 
of Pneumonia at different Ages, 
and in the two sides of the 
Chest. By M. Lombard - ib. 



18. Aneurism of the Right Auri- 
cle without Jugular Pulsation. 

By Mr. Badhara - - 203 

19. Case of Hydrothorax in a Child 
fifteen months old. By M. Lich- 
tenstadt . . - . ib, 

20. Enormous dilatation of the Bi- 
liary Ducts. By M. Berard ib. 

21. Rupture of the Liver and Heart 
from a Fall. By M. Dehanne ib. 



12 



CONTENTS 



Page. 

22. Fatal Hsematemesls. By M. 
Richard .... 204 

23. Diffused Gangrene of the 
Lung-s. By M. Bergeon 

24. Melanosis. By M. Cruveilhier 

25. On Obliteration of the Veins 
as a Cause of (Edema or Partial 
Dropsy, particularly in the lower 
Extremities. By M. Corbin 

26. Remarkable Case of Dropsy. 
By Mr. Fothergill 



ih. 
ib. 



ib. 



205 



Page. 

27. Case of Momentary Suspen- 
sion of Muscular Contractility 
and Sensibility — Disease of the 
Superior Longitudinal Sinus. 

By M. Gintrac - - - 205 

28. Pathology of Erysipelas. By 

Dr. Corbin ... ib. 

29. Amnesia. By M. Cassan - 208 

30. Spinal Irritation. By Mr. Wark 209 

31. Ulceration and Perforation of 
the Heart - - - - 212 



Materia Medica and Pharmact. 



32. Combination of Nitre and Ca- 
lomel. By M. Burdach - 213 

33. Correcter of Opium. By M. 
Puchelt . - - - ib. 

34. New Process for Preparing 
Medicinal Prussic Acid. By Mr. 
Thomas Clark - - - ib. 

35. loduretofLead. By Drs. Cot- 
tereau and Verde Delisle - 214 

36. Solution of Cantharides. By 

Sir Charles Scudamore - ib. 



37. Formula for the Exhibition of 
Hydriodate of Iron - - 214 

38. Medicinal Properties of the 
Sulphuret of Carbon. By MM. 
Wutzer and Pellengham 

39. Formula for Nitrate of Silver 
Ointment. By Mr. Middlemore 

40. Asparagus as a Sedative. By 

M. Eusebe de Salle - - ib. 



215 



ib. 



Practice of Medicine. 



41. Treatment of Croup. By W. 
Goodlad, Esq; - - - 216 

42. White Agaric a cure for Night 
Sweats. ByM. Burdach - 219 

43. On Traumatic Tetanus. By 
Dr. Sym . - - - ib. 

44. Treatment of Gout. By Sir 
Henry Halford - - - 221 

45. Treatment of Chronic Dysen- 
tery by Sulphate of Copper. By 
Dr. Elhotson - - _ - 222 

46. Treatment of Neuralgia by 
Moxa. By Mr. Cooper - 224 

47. Inhalation of Iodine and Chlo- 
rine in Consumption. By Dr. 
Elliotson . - - . ib. 



48. Powdered Alum, a cure for 
the Tooth-ache. By Dr. Kuhn 227 

49. Antidote to Chlorine and to 
Sulphuretted Hydrogen Gas. 

By M. Hunefeld - - ib. 

50. Employment of Calamine to 
Prevent the Pits of Confluent 
Small-Pox. By Mr. George ib. 

51. On Opium in Inflammatory 
Diseases. By Dr. Bow - ib. 

52. On Leucorrhaa. By Dr. Baz- 
zoni 228 

53. Dropsy cured by Kahinga. By 
Dr. Francois - . - ib. 

54. Cure for the Tooth-ache. By 
Dr. Ryan ... - ib. 



Ophthalmologt. 



55. On the Utility of Strychnia in 
certain forms of Amaurosis. By 
Mr. Middlemore 

56. On the efficacy of the Nitrate 
of Silver Ointment in Leucoma, 
and dense opacity of the Cor- 
nea. By Mr. Middlemore - 



228 



233 



57. On Pannus. By Mr. Middle- 
more ... - 233 

58. On Chlovuret of Lime in Pu- 
rulent Ophthalmia. By Dr. 
Herzberg ... - 234 



CONTENTS. 



13 



SURGEKT. 



234 



235 



Page. 

59. Excision of Scirrhous Rectum. 
By M. Lisfranc - - - 

60. Extirpation of Cancer of the 
Rectum. By M. Maurin 

61. Excision of Ulcer of the Rec- 
tum. By Mr. Mayo 

62. Amputation of the Thigh at 
the Hip-Joint. By Dr. Charles 
Bryce . . - - 

63. Lithotrity. By M. Segalas 

64. Lacerated Wound of the Pe- 
rinaeum, with Fracture of the 
Bones of the Pelvis — Recovery. 
By George C. Rankin 



Ih. 



236 
237 



ih. 



Page. 

65. On Traumatic Tetanus. By 
Robert Perry, M. D. - - 239 

66. Wound of the Trachea — Oc- 
clusion of the Larynx — Aerial 
Fistula. By M. Renaud - 241 

67. Case of Severe Scald treated 

by Nitrate of Silver - - 243 

68. Treatmentof Syphilis without 
Mercury. By Dr. Trail - 245 

69. Case of Spontaneous Varicose 
Aneurism. By James Syme, Esq. 246 

70. Lithotrity ... 247 



Midwifery. 

71. Csesarean Operation. By M. i 72. Case of Obliteration of the Va- 

Jolly 248 I gina. By M. Lombard - 248 



Medical Jurisprudence. 



72>. Dr. Knight on the Grinder's 
Phthisis ... - 248 

74. Medico-legal Researches on 
Arsenic. By M. Hunefeld - 251 



75. Poisoning with a Tobacco- 
clyster. By Dr. Grahl - 251 



Medical Statistics. 



76. Half-yearly Report of Cases in 
Midwifery, which have occurred 
in the Northern District of the 
London and Southwark Mid- 



wifery Institution. By C. Wal- 
ler, Esq. - - - - 252 
77. Medical Statistics of Nantz. 
By M. Mareschal - - ih. 



Chemistrt. 



78. Odour of Musk. By M. Bley 253 I 80. Analysis of Urinary Calculi. 

79. Ilicine. By M. Deleschamps ih. \ By W. Twining, Esq. 



81. On Gelatine as an Article of 
Nutriment - - - - 253 



Miscellaneous. 

82. Cholera - 



25: 



255 



AMERICAN INTELLIGENCE. 



Remarks on the Climate of the 
Lower Country of South Caro- 
lina. By Thomas Y. Simons, 
M. D. Port Physician and late 
President of the Medical So- 
ciety 

No. XVII.— Nov. 1831. 



256 



Notice of a Trial for Infanticide. 
By John Andrews, M. D. (Com- 
municated in a letter to R. E. 
Griffith, M. D.) 

Case of Great Abdominal Disor- 
ganization—Death by Apo- 

2 



257 



14 



CONTJ!NTS< 



Page. 
plexy. By Richard D. Moore, 
M. D. one of the House Physi- 
cians of the Philadelphia Alms- 
house - - - - 259 

Case of Aneurism of the Brachial 
Artery, cured by Compression. 
By J. W. Heustis, M. D. of Ca- 
hawba, Alabama - - 261 

Treatment of Ununited Fracture 
with the Seton - - - 262 

Operation of Lithotomy. By Pro- 
fessor Physick - - - 263 

Goupil's Exposition of the Princi- 
ples of the New Medical Doc- 
trines. By Dr. Nott - - ih. 

On Baths and Mineral Waters. By 
Dr. John Bell - - - ih. 

Address to the Medical Society of 
the City and County of New 



VkG%, 

York. By Dr. D. L. M. Peix- 

otto, President of the Society 263 
Faraday's Chemical Manipulation. 

By Dr. J. K. Mitchell - ih. 

Essays on the Materia Medica. By 

Mr. G. W. Carpenter - - ib> 
Louis on Gastro-Enteritis. By Dr. 
F. M. Robertson, of Augusta, 
' Georgia .... ih. 
University of Pennsylvania. — Re- 
solution of the Trustees confer- 
ring on Professor Phihp Syng 
Physick the Honorary appoint- 
ment of Emeritus Professor of 
Surgery and Anatomy - ib. 
Boylston Medical Prize Questions 264 
Medical College of South Caro- 
lina ib. 

University of Maryland - - ib. 

Advbktisements - . - 265 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



Art. I. Medical Statistics; consisting of estimates relating to the 
Population of Philadelphia^ and its changes as influenced by the 
Deaths and Births, during a period of ten years, viz. from 1821 
to 1830 inclusive. By G. Emerson, M. D. 

J^INCE the publication of the views in relation to the medical statis- 
tics of Philadelphia, presented in a former volume of this work, a new 
census has been taken and other data offered, which admit of an exten- 
sion of the investigations to a further period — the commencement of the 
last year. The results developed by a continuation of the calculations, 
are of a highly interesting nature. Among them the most striking are, 
the increased rate of mortality within the last ten years, from epidemic 
causes that have but recently subsided, and the correct ratio of deaths 
for the coloured population, which, for reasons previously explained, 
was necessarily founded in some measure upon assumed data. Add- 
ed to the time contained in former estimates, our calculations now 
embrace a connected series of twenty-four years, namely, frpm the 
year 1807 to 1830 inclusive. 

Population. 

As a proper prelude to our inquiries, we present an abstract from 
the recent census, so as to show the number and description of in- 
habitants included within the built parts of the town, and from which 
the returns of interments are made. For the information of those un- 
acquainted with the municipal divisions of Philadelphia, it may be 
useful to observe that the city proper, or that portion under the con- 
troul of the mayor and councils, embraces but about one-half of the 
population of the whole town — the limits of the original incorporation 

No. XVII.—Nov. 1831. 3 



IS Emerson's Medical Statistics. 

having been overrun in various directions. The parts subsequently 
built, instead of being united to the original incorporation, are formed 
into several distinct districts, each invested with corporate privileges. 

An act of the state legislature, however, extends the provisions of 
the Health Law over the whole, so that the districts, as well as the 
city, have their representatives in the Board of Health. Those who 
attempt calculations of the comparative mortality of Philadelphia, 
without a precise knowledge of the districts which make returns of 
their interments to the Health Office, must necessarily be led into 
erroneous conclusions. For should the sum of the annual mortality 
be compared with a less amount of population than the returns of in- 
terments are made from, the ratio of deaths must appear greater than 
it actually is, and vice versa, should the contrary circumstances pre- 
vail. Gross errors, from such causes, for the most part, have already 
been committed by persons at a distance, and circulated very exten- 
sively both in this country and in Europe. Some of the publications 
alluded to have represented the mortality of Philadelphia as exceeding 
that of the other principal cities in the United States, whereas it has 
been shown to present as low, if not a lower rate than any one of them; 
we mean under ordinary circumstances, and in the absence of those 
epidemic visitations to which all places are subject. 

Reckoning the whole population for the city and county, without 
reference to distinction of colour, the total amount is 188,961, of 
which number 90,332 are males, and 98,620 females. Adopting the 
distinction, the whites amount to 173,345, the blacks to 15,616. 
The increase of the entire population within the city and county con- 
jointly, since the year 1820, is 51,864, being in the ratio of 37. 8 per 
cent, for the whole period, or aii average of 3^ per cent, per annum.* 
The white increase estimated separately amounts to 49,599, or 40 
per cent, for the ten years, being at the rate of about 3| per cent. 
per annum. ' The increase of blacks alone for the ten years is 
3732, being at the rate of about 311 per cent, or 2| per cent, per 
annum.! 

But it is that portion of our population embraced within the limits 
of the bills of mortality, which interests us most particularly. This 
alone is exhibited in our abstract, or table marked A. and amounts 

* This ratio, it must be observed, is computed upon geometrical principles, 
as approaching nearest to the rate at which population ordinarily increases, and 
not upon the arithmetical usually resorted to. 

\ Much interesting information relative to the changes and denseness of po- 
pulation in the city and county of Philadelphia, may be found in Hazzard's 
Pennsylvania Register, Vol. 8. 



Emerson's Medical Statistics. 1 9 

without distinction of colour, to 167,811. Compared with the popu- 
lation existing in 1820, we find an increase of 40.6 per cent, within 
the last ten years. 

The white population considered separately, shows an increase 
greater than the general ratio just mentioned. The total amount is 
153,169, and the increase during the ten years is 41.6 per cent. 
Estimating the sexes separately, there are 73,547 males, and 79,622 
females, so that the last exceed the first in the ratio of 8| per cent. 
or in other words, there are about 100 females to 92 males. 

We find the ages of each of the sexes distributed into thirteen pe- 
riods, commencing with those of and under the 5th year, then giving 
the number between the 5th and lOfh, the 10th and 15th, the 15th 
and 20th, the 20th and SOth years, and so on to the most protracted 
periods of life. On comparing this division with that adopted when 
the former enumerations were made, it will be found to difter very 
materially, more than double the number of periods being given. 

With the whites, the number of both sexes at difterent ages, com- 
pared with the total amount at all ages, stands thus: — All those 
Of and under 5 years, constitute 14.6 per ct. of the whole population. 

26.9 do. 

37.6 do. 

50.3 do. 

28.1 do. 

14.6 do. 

8. do. 

3.2 do. 

1.08 do. 

0.28 do. 

about 4.5 per 10,000. 
about Q.5 per 100,000. 
In the period first marked, namely, that including all of and un- 
der the 5th year, the males exceed the females about 5 per cent.* 
but in that which includes those between the 5th and 10th years, the 
mlale excess has diminished so as to be only about 1 per cent. 

Iij the next five years, namely, between the 10th and 15th years, 
the females exceed the males about 8 per cent, and from this last 
named period to the 50th year, the excess continues pretty steadily 
in the ratio of from 8 to 10 per cent. Afterwards, however, it in- 
creases greatly, so that 

* An examination of the table of births will show that the number of males 
at birth exceeds that of the females more than 7 per cent. 



Do. 10 




Do. 15 




Do. 20 




and over SO 




Do. 40 




Do. 50 




Do. 60 




Do. 70 




Do. 80 




Do. 90 




Do. 100 





20 Emerson's Medical Statistics* 

Between the 50th and 60th yr's, the females exceed the males 34 perct. 
'« 60th and 70th '' " '' 59 " 

'« 70th and 80th '' '' '' 90 " 

" 80th and 90th <' '« *« 79 " 

'' 90th and 100th " " " 40 '« 

Of those who had attained and exceeded a century, seven were fe- 
males and three males. 

The Blacks constitute about 8.7 per cent, of the whole population 
within the limits embraced bj the bills of mortality. They have in- 
creased within the last ten years 28 per cent, or in a ratio of about 
2.7 per cent, per annum — a much lower rate than that of the whites. 
The whole amount included in our abstract is 14,642, of which 
6307 are males, and 8335 females. The disparity between the sexes 
is therefore far greater than we find in the white population, the ex- 
cess of females amounting to 32 per cent, or nearly a third. This is 
partly owing to the circumstance of the services of females being in 
more general demand in cities than in the country, and partly to the 
greater mortality of the males. The distribution into periods differs 
from that adopted for the whites, only six being given, instead of 
thirteen. The first designated is the 10th year, and the females of 
and under that age, exceed the males about 5 per cent. In that 
Between the 10th and 24th years, the female excess is about 61 per ct 
*' 24th and 36th " " " 36 " 

" S6th and 55th " '' '' 16 " 

'« 55th and 100th " «« '« 38 " 

With the black population, the number of both sexes at different 
periods of life, compared with the total amount at all ages, stands 
thus: — 

All under 10 years, constitute 21.7 per cent. 

All over 36 " '' 22.1 " 

" 55 " «« 5.9 " 

" 100 " '' 1.7 or nearly 2 per 1000. 

Of those that had attained 100 years and over, 14 were males and 
12 females. It is curious to observe, that notwithstanding their small 
numbers when compared with the whites, they greatly exceed the 
latter in the proportion of their centenarians, and that with the blacks 
the number of male centenarians exceeds that of the female. From 
the difficulty which frequently occurs of ascertaining the ages 
of blacks with certainty, it is possible that more of them are report^ 
ed among the instances of extreme longevity, tlian are entitled to the 
distinction. 



Emerson's Medical Statistics^ 21 



Births. 



In our former publication we were only enabled to present an ac- 
count of the births for six years. We can now extend the period so 
as to embrace ten years, namely, from 1821 to 1830 inclusive. As 
the accuracy of the data upon which our calculations are founded, 
depends for the most part upon the character of those by whom the 
returns are made, that is to say, the accoucheurs, we think it proper 
to premise that the obstetric practice of Philadelphia is mostly in the 
hands of the physicians. In the last year, for instance, the register 
at the Health Oflfice contained the names of one hundred and fifty- 
five practitioners of midwifery for the city and suburbs, of which 
number only twenty-one were females, the remaining one hundred 
and thirty-four being regular physicians, of whom some possess a very 
limited portion of practice, whilst others have a very great monopoly. 
Of the total number of births for the year mentioned, viz. 7628, the 
amount delivered by the female accoucheurs was 1061 — leaving the 
balance of 6567 to be divided among the male practitioners. It thus 
appears that most of the returns of births are made in Philadelphia, 
by those whose standing for probity and intelligence should entitle 
their statements to credit. Whether all the births which take place 
are reported, is, we think, somewhat doubtful, though the number 
omitted may not be very large. The average proportion compared to 
the population, is about 4.42 per cent, per annum. 

Upon running the eye along the columns of table B. we are struck 
with the variations appearing from year to year, not only in the to- 
tals, but in the respective proportions of the sexes. There is also a 
considerable deficiency conspicuous in the total for the year 1829, 
which induced us to suppose that a mistake had been somewhere 
committed, but upon the most careful examination of the original re- 
cord, we found the returns complete from all the various practition- 
ers, and were unable to perceive any error in the computation. It is 
a fact of the highesi; interest, that although the males at birth for the 
whole period exceed the females by more than 7 per cent, such is the 
greater ratio of mortality among them during the first years of life, 
that at the fifth year the excess of males is only about 5 per cent, 
whilst by the tenth year it has been so reduced that the excess is 
only about 1 per cent. Referring to the table exhibiting the popula- 
tion at different ages for the evidences of our representations, we 
shall not stop to indulge in the speculations which this subject seems 
to invite. 

In consequence of some curious investigations made lately by M. 

3* 



22 



Emerson^s Medical Statistics. 



ViLLERME, of Paris,* we have been induced to construct a taljle of 
the births in Philadelphia for the last ten years, so as to present the 
amount of each sex per month, (Table C.) This was a very ar- 
duous and troublesome task, as from the manner in which the re- 
cord is kept, we were obliged to refer to the separate statements 
made by the various practitioners in the respective years em- 
braced by our tablet Having obtain'ed the amount of the births for 
each of the months in the period mentioned, and calculated their 
sums, it was next necessary, in order to institute a fair comparison, 
to equalize them, by making all of the value of thirty-one days. In 
effecting this, we followed the rule given byM. Villerme, which con- 
sists in ascertaining for each of the short months the average number 
of births per day, and multiplying this sum by thirty -one. By pur- 
suing this process, the following results were obtained, which we ar- 
range in such manner as to give the highest place to the months pre- 
senting the greatest number of births, and the corresponding months 
of conception, which last are seen on the right. 





"Whole No, 






Correspond, mos. 


Month. 


of Bhths. 


Males. 


Females. 


of Conception. 


1. February 


- 5996 - 


3099 


- 2897 


- May. 


2. September 


- 5965 - 


3112 


- 2853 


- December. 


S. December 


- 5937 - 


3023 


- 2914 


- March. 


4. January - 


- 5712 - 


3012 


- 2700 


- April. 


5. November 


- 5652 - 


2954 


- 2698 


- February. 


6. March 


- 5598 - 


2896 


- 2702 


- June. 


7. October - 


- 5567 - 


2941 


- 2626 


- January. 


8. August - 


- 5437 - 


2798 


- 2639 


- November. 


9. July - - 


- 5221 - 


2764 


2457 


- October. 


10. June - - 


- 4855 - 


2523 


- 2332 


- September. 


11. April - - 


- 4805 - 


2515 


- 2290 


- July. 


12. May - - 


- 4797 - 


2503 


- 2294 


- August. 



It would hence appear that the locality of Philadelphia is subjected 
to the influence of some causes, which, during a portion of the year, 
operate unfavourably upon the increase of its population by repro- 
duction. These causes seem to prevail during the extreme heat of 
summer, and in the commencement of autumn, the months of August, 



* De la distribution par mois des Conceptions et des naissances de Thomme. 
Annales d'Hygiene Publique et de Medecine Legale. 

f The sums of births per annum exhibited in this table, will sometimes be 
found less than those reported annually by the Board of Health. This arises 
from the rejection of some returns made by the quarter or year, instead of the 
month. 



Emerson's Medical Statistics. 23 

July, and September, standing lowest in the scale designating the 
months of conception. 

As we are unacquainted with any circumstances connected with 
tlie social customs or institutions of the place, sufficient to account 
for the variation so obvious at diflerent seasons in the births and con- 
ceptions, we feel ourselves constrained to adopt the explanation pro- 
posed by M. Yillerme, who attributes it to the influence, either di- 
rect or indirect, of the annual revolution of the earth around the sun, 
or in other words, to the order of the seasons. It will no doubt be gra- 
tifying to the investigator of this novel subject, to have the main con- 
clusion which he has derived from his extensive researches in Eu- 
rope, confirmed by calculations made in this part of the globe. From 
an inspection of our statement, it will be seen that its results are in 
singular accordance with the observation of M. Yillerme, ''c'estadire, 
que les mois de Juillet, Aout et Septembre, qui sont les plus chauds, 
efferent comparee aux autres mois de Panne, une diminution notable 
dans la force generatrice." But although the results of our observa- 
tions correspond thus strictly with his in regard to the minimum of 
births and conceptions, they are found to vary in respect to the maxi- 
mum^ as will be seen by comparing our statement with that one of his 
general conclusions, which asserts that '' toujoiirs et part out, a des vari- 
ations pres fortlimitees, la fin du printemps, le commencement de I'ete, 
offrent les plus grand nombre des conceptions," &c. As, however, 
the thermometrical observations made in this locality,* will exhibit a 
striking difference between the climate and seasons of this part of 
America, and those of the various parts of the European continent 
comprehended in M. Yillerme's calculations, some difference in the 
results was to be naturally expected. Should similar investigations 
lie made in other sections of our own country, which from its extent 
presents such diversity of climate, they will no doubt exhibit corres- 
ponding variations in the results, but still, we think, support M. Yil- 
lerme's lea-ding principle, relative to solar influence upon the propa- 
gation of the human species. 

Before we conclude our remarks upon this subject, we would in- 
vite attention to a fact which perhaps will go further to account for 
the variations in the number of births existing between the differ- 
ent months, than any other circumstance, independent of temperature. 

An estimate made so as to include those three years of the series least 
affected by the epidemic causes we have adverted to, would present 
a different order in the months, from one made to include a like num- 
ber of years most subject to these influences. Let us take for exam- 

* See Vol. I. of this Journal, art. Medical Statistics of Philadelphia, Table I. 



B4 



Emerson's Medical Statistics, 



Month. 



1. 



September 

February 

December 

January - 

March 

November 

7. October - 

8. August - 

9. July 

10. April 

11. May 

12. June 



Corresponding months 
of Conception. 
December. 
May. 
March. 
April. 
June. 
February. 
January. 
November. 
October. 
July. 
August. 
September. 



pie the three last years of our series, viz. 1828, 1829, and 1830 — 
during which the epidemic has been felt much more slightly than 
during the seven preceding years. Their order when arranged ac- 
cording to the plan previously adopted, would differ but little from 
that presented by the whole series, and would stand as follows, reckon- 
ing all the months to have thirty-one days: — 

No. of 
Births. 

2047 

1995 

1951 

1947 

1913 

1885 

1836 

1785 

1719 

1664 

1658 

1610 

When, however, we make a similar estimate for the three years, 
which, from their great mortality, we may suppose felt the epidemic 
influences in the highest degree, viz. 1823, 1824, and 1825, we find 
some variation, the months arranged according to the decreasing ra- 
tio of births and conceptions taking the following order: — 

No. of 
Births. 

1685 

1674 

1645 

1629 

1581 

1569 

1540 

1497 

1487 

1416 

1372 

1317 

In this last estimate we see but little change in the situation of 
the months presenting the extremes, or maximum and minimum of 
births and conceptions. We find, however, a sensible diminution in 
the proportion of conceptions for the months of June and October. 



Month. 

1. September 

2. December 

3. October - 

4. February 

5. January - 

6. August - 

7. November 

8. July 

9. March 

10. April 

11. June 

12. May 



Corresponding months 
of Conception. 
December. 
March. 
January. 
May. 
April. 
November. 
February. 
October. 
June. 
July. 

September. 
August 



Emerson's Medical Statistics. 25 

Now in the first of these months we know that the epidemic forms of 
disease seemed to revive for the season with great force, and con- 
tinue until October. We therefore think it a demonstrable fact, that 
in addition to the principal influence which lessens fecundity in this 
locality, namely, that of high temperature, there has existed during 
the period embraced by our calculation, another retarding force con- 
nected with the late epidemic. 

As the results of our observations are in accordance with those ob- 
tained by M. Villerme from extensive data procured in those parts of 
France subject to endemic influences, we do not think it necessary 
to pursue these calculations further. 

We terminate this portion of our investigations with the following 
general conclusions: — 

1. That the chief cause which operates in our locality in retarding 
the natural increase of the population, appears to be the extreme heat 
of summer and the insalubrity of the first months of autumn. 

2. That another cause which has tended to check fecundity dur- 
ing the last ten years, may be traced to the epidemic influences to 
which the population of the environs of the town were subjected. 
This of course is not a regular, but merely an occasional cause. 

3. That the prevalence of epidemics or extensive sickness among 
adults, tends not only to diminish population directly, by increasing 
mortality, but indirectly, by diminishing fecundity. 

4. That upon examination of the births and deaths of particular 
years, the maximum of conceptions will almost invariably be found 
corresponding to the minimum of adult mortality, and vice versa, 
the maximum of deaths agreeing with the minimum of conceptions. 

According to M. Villerme's investigations, the disparity existing 
between the births and conceptions of the different seasons is much 
more strongly marked in the country and small towns than in the 
large cities. We possess no data by which we can ascertain whether 
this observation is equally applicable to this country. 

Deaths. 

The proportion of deaths to the population for the last ten years is 
exhibited in table D. and proves greater than it has been at any pe- 
riod since regular records of mortality have been kept. The lowest 
rate was in the last year, (1830,) when it was one death in 42.94 in- 
habitants, or 2.32 per cent, of the population. The highest degree of 
mortality occurred in 1823, and was at the rate of one death in 30.5 
inhabitants, or 3.26 per cent, of the population. The average of the 
whole period is one death in 38.85 inhabitants. These estimates aro 



26 Emerson's Medical Statistics. 

made without reference to distinction of colour, and exclusive of 
still-born. 

This ratio so far exceeds that of the fourteen preceding years, 
when it was one year as low as one death in 56.53 inhabitants, and 
on an average for the whole period, one in 47.86 of the population 
generally, and only one in about 51 of the whites, that we feel call- 
ed upon to enter into some investigation of its causes. 

Upon referring to the tables accompanying these and our for- 
mer calculations, exhibiting the annual mortality, it will be seen 
that in the year 1818 a very sudden increase took place in the 
amount of deaths. An examination of the tables giving the parti- 
cular diseases from which these occurred, shows that this increase 
may be traced for the most part to an unusual prevalence of fevers, 
inflammations, and bowel complaints, or in other words, to epidemic 
causes, which were felt with greatest violence from 1818 to 1826, 
and more especially in the years 1828, 1823, and 1824.* It is a cu- 
rious fact, that although the same influences which promoted fevers 
seemed to operate in producing an increase of bowel complaints, the 
mortality from this last source should not have diminished in a pro- 
portion similar to that of fevers, whilst with regard to inflammations 
there has been a striking increase with the subsidence of fevers. It 
is possible that the new nomenclature of the physiological school of 
medicine may have occasioned some of these last to be enumerated 
with the phlegmasise, but the number we are sure must have been 



• To make this more apparent, we subjoin the following abstract from the ta- 
bles. The first years are added for the purpose of showing the ordinary morta- 
lity previously to the commencement of the epidemic. 



Year. 


Total 
mortality. 


Fever^. 


Inflamma- 
tions. 


Bowel 

compl'nts. 


Consump- 
tion. 


Dropsies. 


1816 


2225 


193 


229 


153 


434 


156 


1817 


2107 


211 


205 


229 


349 


149 


1818 


2609 


492 


195 


283 


396 


171 


1819 


2979 


277 


265 


363 


459 


231 


1820 


3189 


526 


275 


454 


446 


209 


1821 


2161 


402 


289 


380 


438 


194 


1822 


3334 


498 


284 


461 


488 


243 


1823 


4372 


744 


339 


562 


536 


241 


1824 


4284 


647 


402 


297 


576 


221 


1825 


3539 


362 


338 


362 


519 


270 


1826 


3845 


421 


447 


415 


587 


242 


1827 


3659 


365 


481 


384 


523 


219 


1828 


3971 


373 


483 


429 


581 


253 


1829 


4001 


260 


631 


394 


638 


287 


1830 


3948 


228 


505 


361 


636 


281 



Emersoh's Medical Statistics. 27 

very limited, as may be seen by referring to the particular kinds of 
inflammation. 

In a former number of this journal we took some pains to show 
tiiat the influence of the sickly air was expended upon that compara- 
tively limited portion of the population living in the environs and 
outskirts of the town. With these, fever in some of its forms was al- 
most universal, whilst in the more dense and well paved parts, the 
air seemed unusually healthy, and where remittents and intermittents 
were met with, they could almost invariably be traced to exposure 
to night air in the country or suburbs. Never was a stronger demon- 
stration afforded of the resistance made by cities to the influence of 
country malaria than our late experience has furnished. Great as was 
the amount of sickness, it was confined almost entirely to the com- 
paratively small proportion of population inhabiting the unpaved or 
ill-paved environs. Our observation on this and other occasions, 
has led us to ascribe this exemption for the most part to the pave- 
ments, which, by effecting a perfect draining, prevents exhalation, 
at the same time that it admits of the total removal of vegetable and 
animal matters, the sources of foul and unhealthy emanations. The 
chief motive for paving the streets and side walks, is usually conve- 
nience, but it has always appeared to us, that by far the most impor- 
tant object achieved by it was the preservation of health. 

Whilst upon the subject of public hygiene, we cannot restrair omt- 
selves from noticing another consideration connected with it, namely, 
ventilation, or a proper supply of pure unrespired air. By far the 
greatest proportion of the annual sickness and mortality of ordinary 
seasons is furnished by the narrow and confined alleys and courts ex- 
isting in various parts of the town. The low terms upon which the 
small houses and rooms in such places can be obtained, causes them 
to be literally crowded with a class of population for the most part 
negligent of cleanliness, and it can occasion no surprize that there 
should be a great disparity between the proportions of sickness and 
mortality among these, compared with that which takes place in the 
portion living in larger dwellings, having a freer circulation of air. 
The difference just mentioned, though sufficiently obvious in adults, 
is most lamentably conspicuous among children Notwithstanding 
the great numbers of these which die annually of cholera, we feel our- 
selves warranted in asserting that deaths from this disease are rare 
in houses with large and well-aired apartments. To one who in the 
capacity of physician to a dispensary or other charity, has been en- 
gaged in the arduous duties of attending the poor in their uncomfort- 
able abodes, evidences of our assertions must be abundantly familiar. 



28 . Emerson's Medical Statistics, 

The numerous instances wherein the mercenary calculations of indi- 
viduals has tempted them to put up nests of contracted tenements in 
courts or alleys admitting but little air, and yet subjected to the full 
influence of heat, has often induced us to wish that there could be 
some public regulation by which the evil might be checked. Man- 
kind have inhabited cities long enough to know from severe experience, 
that there are certain limits to the denseness of population, which 
when passed, always lead to disease and mortality. As we think 
every thing tending to the preservation of public health must be a fit 
subject for legislation, we do not see why a law should not be pro- 
cured by which the undue crowding of population might be prevent- 
ed, and the number and size of dwellings adjusted to superficial li- 
mits. There are at present municipal regulations intended as a pro- 
tection against conflagration, by designating the materials of which 
houses shall be constructed; and if such precautions be deemed so 
important when property is the consideration, of how much more 
consequence would be those for the preservation of health and life. 

It is common to attribute the greater mortality known to take 
place under ordinary circumstances in large towns among the 
poorer classes, chiefly to meagre or unwholesome food and immo- 
derate indulgence in strong liquors. But in this country, where for 
a part of the year we are subjected to a degree of heat little if at all 
below that of the tropics, the influence of both these causes in the 
production of disease, is, in our opinion, insignificant, when compar- 
ed to that of breathing air that has been previously respired, and 
which, moreover, is commonly charged with animal and vegetable 
efiluvia. That the same diet and habits of life in the country or small 
towns, would not be attended with a degree of sickness and mortality 
corresponding to that found in the crowded portions of large towns, 
is, we think, beyond a doubt. 

In Paris, comparisons instituted between the parts chiefly occupied 
by such as live at ease, with those inhabited by the poorer orders, 
would seem to show that the proportion of mortality is regulated less 
by the density of population, than by the opposite circumstances of 
ease and poverty.* That this may be the case under the circumstances 
ofclimateandmeansof nourishment which exist there, we will not pre- 

* The results of the extensive and extremely interesting researches of M. 
Villot relative to the chang-es in the population of Paris, show that the three 
arrondissements presenting- the smallest portion of mortality, namely, an average 
of one in forty-two of the population per annum, are precisely those recog- 
nised as the richest, whilst the three presenting the greatest rate, namely, about 
one in twenty-five, are noted as the poorest. 



Emerson's Medical Statistics. 29 

tend to denyi but in this country, where absolute want of food, and 
that of the best kind, is unknown, the evils of poverty we are con- 
vinced come from different sources, and more especially from those 
we have mentioned. 

Those desirous of examining into the immediate sources of the 
mortality of Philadelphia for the four years from 1827 to 1830 inclu- 
sive, are referred to table E. which contains the amount from each 
particular disease, or other cause. We have thought it unnecessary 
to include the preceding years, there being a similar calculation for 
them in the tables previously given in this Journal. 

An examination of our records of mortality for the last twenty -five 
years, will show that during the whole time, the number of deaths 
from malignmt or yellotv fever is only about 125. This information 
may appear strange, even at home; but how much more so abroad, in 
Europe for instance, where the dread of this disease has alone per- 
haps deterred many from visiting the country, and raised obstacles 
to our commerce by the enforcement of vexatious quarantine regula- 
tions in many ports. The simple fact we have here stated relative to 
our exemption from yellow fever, should, we think, entitle our vessels 
to general pratique, or at least lessen very greatly the detention to 
which they are so frequently subjected, especially in the South of 
Europe. 

To what this great exemption for so long a period is to be ascrib- 
ed, and what share of the happy influence has been exerted by qua- 
rantine regulations, more general and better paving, with greater 
cleanliness, are questions it would be very interesting to solve. 

The various periods of life at which the deaths occurred, are exhi- 
bited in table G. from which it appears that the deaths of such as 
were under the 
1st year, constitute about 48 per ct. or nearlyone-half of all those un- 
der the 20th year, and 
22 perct. of the mortality at all ages. 
2d " " 66 per ct. of all under the 20th year, and 

about 
31 per ct. of the mortality at all ages. 
5th " '' 81 per ct. of all under the 20th year, and 

about 
35 per ct. of the mortality at all ages. 
10th *' " 89 per ct. of all under the 20th year, or 

about 
42 per ct. of the mortality at all ages. 
No. XVII.— Nov. 1831. 4 



3p Emerson's Medical Statistics. 

15th year, constitute about 93 per ct. of all under the 20th year, and 

about 
44 per ct. of the mortality at all ages. 
20th '' " 47 " " " 

All over the 
SOth year, constitute about 40 per ct. of the mortality at all ages. 
40th " '' 28 

50th '^ ■'' 18 

60th '' " 11.3 

70th '^ " 6.2 

80th '' " 2.3 

90th <-' " 0.7 

100th " " 0.001, or about 1 in 1000. 

For the purpose of ascertaining whether any influence was exerted 
by the late epidemic visitation upon the mean duration of human life 
as formerly determined, we have included a series of ten years in 
our table. The result of the estimate shows a diminution in the mean 
duration from that exhibited by our former calculations, which were 
founded upon data furnished by the fourteen previous years, namely, 
from 1807 to 1820 inclusive. The average for the last ten years is 
28.53, whilst that formerly presented for the period mentioned, was 
29.40. In the year 1823, when the greatest mortality occurred, the 
mean duration fell as low as 26.67. It is not pretended, as we have 
elsewhere stated, that calculations founded on such data as we pos- 
sess, can give the mean duration of human life for Philadelphia with 
precision, one important obstacle to the attainment of which is, that 
the periods of mortality designated are not sufficiently numerous. It 
is however the nearest approach that present circumstances will ad- 
mit us to make towards ascertaining this important point relative to 
the laws of mortality. For the purposes of regulating estimates of 
risk and adventure, it would we think for several reasons, afford a 
safe minimum. 

The mean duration of life for that portion of inhabitants residing 
in the more central parts of the town, in good houses, and abundant- 
ly provided with all the necessaries of life, must be much above that 
of the general average for all conditions, including the blacks as well 
as the poorer class of whites. Now, as these last, though they furnish 
by far the largest proportion of mortality, and consequently present 
the greatest risks, seldom apply for life insurance or annuities, it is 
evident that ventures founded upon estimates of the chances of life 
in which they are included, must afford great profit, insurance being 
commonly effected upon that class in which the average value of life 
is much the greatest. 



Emerson's Medical Statistics. 31 

With regard to the mortality of particular diseases, as exhibited in 
table F. we have not much to add to what we have already mention- 
ed either on this or the former occasion. It has been shown that fe- 
vers, bowel complaints, and inflammations have been much more pre- 
valent within the period included in the present calculations than in 
that embraced by the preceding. This will perhaps be most strikingly 
demonstrated thus: — 

The average mortality oifevers^ from 1807 to 1817 inclusive, was 

in the proportion of 1 in 13, or 7>7 per cent, of the whole mortality. 

-Put since that time, and from the year 1818 to 1828 inclusive, the 

average has been as great as 1 in 7.4, or IS^ per cent, of the whole 

mortality, nearly double its usual rate. 

The average proportion from bowel complaints for the same periods 
has altered but little, notwithstanding the great increase observed in 
their number since the commencement of the epidemic. For the first 
mentioned period it was one in 8.3 or 12 per cent, of the total mor- 
tality, and for the last, 1 in 8.6 or 11.5 per cent, of the mortality. 

The proportional increase in the mortality from infiammations, in 
the last period though more apparent than that of bowel complaints, 
is much less marked than that of fevers. The average of the first 
eleven years is 1 in 11. 8 or 8.4 per cent.j that of the following eleven 
years, 1 in 9.9, or 10 per cent. During the last five years, viz. from 
1826 to 1830 inclusive, the average has increased so as to constitute 
13 per cent, of the entire mortality, which it will be seen is very 
nearly the proportion of fevers when these were most prevalent. 

Of dropsies^ the average proportion for the first period is 1 in 16, 
or 6.2 per cent, of the whole mortality, which rate was slightly in- 
creased during the last or epidemic period, so as to constitute 1 in 
15, or 6. 6 per cent, of the entire mortality. During the last five 
years, which, as already shown, has been distinguished by the preva- 
lence of inflammatory disorders, the proportional mortality from 
dropsies, has been about equal to what it was during the greatest 
prevalence of fevers, proving that the agency of both forms of disease 
in the production of hydropic aftections is about equal. 

Contrary to what we have found to be the case in regard to the 
proportional mortality from the last mentioned diseases, that from C07i- 
sumption, compared with the general mortality, has rather diminish- 
ed during the existence of the epidemic influences. Thus v/e find 
the average for the eleven years from 1807 to 1818, inclusive, to be 
1 in 6.3, or 15 per cent, whilst for the following eleven years, it was 
as in 6.8, or 14.6 per cent. During the last five years, that is to say, 
since the subsidence of fevers and increase of inflammatory disorders, 
the average mortality from consumption, compared to the general 



32 



Emerson's Medical Statistics, 



mortality, has been 1 in 6.5, or 15.3 per cent. It must not be forgot- 
ten that in estimating these several ratios, the still-born were deduct- 
ed from the yearly sums of mortality; had they been retained, as 
they often are in such calculations, the proportional mortality of par- 
ticular diseases would of course appear much less. 

Estimates formerly given exhibited the influence of the months and 
seasons upon the mortality both of adults and children. It was shown 
from a series of observations including twenty years, how the relative 
mortality of the months for adults stood, when arranged according 
to the order of their decreasing mortality. As we did not then show 
the respective proportions of the months when all made eq^ual to thirty- 
one days, we now adopt this measure. The result for the twenty years 
specified is the following order and distribution: — * 



1. August - 


- 


6632 


7. April - 


- 


- 


4370 


2. July 


r 


5887 


8. November 


- 


- 


4361 


3. September 


-/ . - 


5309 


9. February 


-' 


- 


4283 


4. June 


'' ■ ■'''■^'' 


4699 


10. January 


- 


- 


4112 


5. October - 


- ■ - 


4554 


11. December 


- 


- 


4072 


6. March - 


- 


4371 


12. May - 


- 


- - 


3892 


Arranged according to the mortality of adults alone 


, and s 


mppos- 


ing them all to consist of thirty-one days, the months 


placed 


in the 


order of their decreasing mortality, would stand thus:- 


— . 




1. August - 


- 


2845 


7. November 


- 


- 


2432 


2. September 


- 


2716 


8. July - 


- 


- 


2429 


3. April 


- 


2609 


9. June 


- 


- 


2409 


4. October - 


- 


2560 


10. January 


- 


- 


2390 


5. February 


- , 


2501 


11. December 


-,, 


- 


2252 


6. March - 


- ,. ■-■- 


2480 


•12. May - • 


- 


; 


2224 


The relative 


mortality 


of the several months for those 


under 


twenty years of 


age, would stand, according to a 


similar arrange- 


ment, thus:— 












1. August - 


- 


3787 


7. March - 


- 


- 


1891 


2. July 


- ' . - ■ 


3458 


8. December 


- 


- 


1820 


3. September 


r - 


2591 


9. February 


„ 


- 


1782 


4. June 


■-'■■■ -' 


2290 


10. April - 


= 


- 


1761 


5. October - 


- 


1994 


ll. January 


» 


- 


1722 


6. November 


- 


1929 


12. May - 


. 


- 


1668 



* See Table IV. of our former series of calculations. It may be proper to ob- 
serve that the present is one of the few instances, in which the still-born have 
not beea deducted in our estimates of mortality. As, however, our object is to 
show the relative, and not the actual mortality, their exclusion would nothavQ 
altered the results. 



Emerson's Medical Statistics, 33 

The influence of the seasons in the production of the mortality of 
both adults and children in our locality, is rendered strikingly con- 
spicuous by this mode of calculation. In the estimates for children, 
the disparity existing between the months exhibiting the maximum 
and minimum, or greatest and least proportions of deaths, compared 
with the difference between the months showing the like proportions 
for adults, demonstrates most forcibly how much more under the in- 
fluence of the seasons those in the early periods of life are, than such 
as have arrived at maturity. With adults the difference in these ex- 
tremes is only about 21 per cent, whilst that of children is no less than 
55 per cent. For the purpose of investigating this interesting subject in 
still greater detail, we have constructed table H. which exhibits the 
infantile mortality per month at the respective ages or periods of life. 
A period of five years was deemed quite ample for this purpose, and 
instead of returning to the time embraced in our first, we have taken 
them from the last years of our estimates. Tlie periods designated 
in our table are four — the first giving the mortality under the first 
year; the second, that occurring between the first and second years; 
the third, that between the second and fifth years; and the fourth and 
last, which embraces no less than fifteen years of life, namely, from 
the fifth year to the twentieth. The proportion of still-born were de- 
ducted from the mortality under the first year. 

The months of the five years equalized and exhibited in the order 
of their decreasing mortality, with their respective proportions, 
stand thus: — 





Under 


Between 


Between 


Between 






1 year. 


land 2 


2 and 5 


5 and 20. 


Totals. 


1. July - 


836 - 


- 249 - 


- 117 - 


- 120 - 


- 1322 


2. August 


546 - 


- 317 - 


- 120 - 


- 165 - 


- 1148 


3. Sept. - 


377 - 


- 221 - 


- 140 - 


- 185 - 


- 923 


4. June - 


510 - 


- 148 - 


- 84 - 


- 105 - 


- 847 


5. February 


382 - 


- 109 - 


- 123 - 


- 131 - 


- 745 


6. October 


324 - 


- 127 - 


- 117 - 


- 153 - 


- 721 


7. March - 


322 - 


- 119 - 


- 122 - 


- 138 - 


- 701 


8. April - 


342 - 


- 107 - 


- 125 - 


- 122 - 


- 696 


9. Dec. - 


269 - 


- 90 - 


- 114 - 


- 135 - 


- 608 


10. Nov. - 


267 - 


- 90 - 


- 114 - 


- 132 - 


- 603 


11. January 


281 - 


- 81 - 


- 102 - 


- 109 - 


- - 573 


12. May - 


250 - 


- 98 - 


- 107 - 


- 107 - 


- 562 



4706 - -1756 - -1385 - -1602 - - 9449 
It hence appears that by far the greatest mortality occurring in 



34 Emerson's Medical Statistics, 

childhood takes place in July, June, and August, months dis- 
tinguished from all others by their high temperature, and that 
heat is the great enemy of early life in our city.* It is interesting 
to observe that the destructive influence of this agent has lost much 
of its power after the first year of life, and that after the second year 
it is scarcely perceptible, there being but little variation in the co- 
lumns representing the monthly mortality after this period. 

If vfQ take the mortality for the months of June, July, and August, 
we find that the proportion occurring iinder the second year of in- 
fancy is about four times greater than that which occurred during the 
same months for tbe whole eighteen succeeding years of life^ where- 
as, for the three months of November, December, and January, the 
amount of mortality under the two first years of life,^is but little 
above that of the eighteen succeeding years. 

It will be observed that the month of September stands among the 
highest months in the scale of infantile mortality, diflering however 
from those with which it is associated, by having a larger proportion 
of deaths distributed under the later periods designated. 

For the diseases proving most frequently fatal to childhood, with 
the ages at which they occur, we refer to Table VIII. of our calcu- 
lations formerly published. 

At the time of making our first series of statistical calculations we 
were so deficient in the data necessary for ascertaining the correct pro- 
portion of mortality for the black population separately, that we were 
compelled as we then stated, to appeal to conjecture for some of 
them, or abandon the interesting subject entirely. We are now 
happy to have it in our power to place our estimates upon a better 
foundation, possessing not only a longer period for observation, but 
being furnished through the census taken last year with the exact 
proportion of this class of the population. In Table E. we have ex- 
hibited the respective proportions of both white and black mortality 
and population, with the annual ratio of deaths in each, during the 
ten years from 1821 to 1830 inclusive. This estimate differs in some 
respects from the one formerly given, one of which is, that the pro- 
portion of still-born has been deducted, a circumstance calculated, 
as we have before observed, to lessen the rate of mortality compared 
to population, but to increase the proportion from particular diseases 
compared with the whole. 

* For the average temperature of these and other months in Philadelphia, we 
refer to Table I. of our former calculations. 



Emerson's Medical Statistics, 35 

The result of our calculations shows a disparity in the proportions 
of white and black mortality^ compared with the population, which 
though riot quite equal to what we had computed it for the five years 
succeeding 1820, is still most appalling for the African descend- 
ants. The greatest mortality among these in any single year was in 
1820, when it amounted to 1 death in 16.9 inhabitants. The small- 
est in 1830, when the ratio was 1 in 27.2. The average for the 
whole ten years is 1 in 21.7, whilst that for the whites alone during 
this unusually sickly period is 1 in 42. 3. The lowest rate of morta- 
lity for the whites occurred in 1821, and was 1 in 49.1 inhabitants, 
the highest in 1823, when it amounted to 1 in 33.8. We regret ex- 
ceedingly that the black mortality was not recorded separately for 
some time previous to 1820, as we should then have been enabled to 
ascertain its exact proportion in the years when a fever prevailed in 
some parts of the town, which confined its attacks to the blacks alone, 
sparing the whites that even lived among them.* 

The fact last mentioned is of itself suflicient proof of the existence 
of some peculiarity in the African constitution, which distinguishes 
it from that of the white, and when connected with the opposite cir- 
cumstances of their much greater exemption from some other varieties 
of fever, to which whites are extremely liable on the application of 
the causes, as for example, the yellow and even intermittent forms, the 
evidence is rendered still more positive. 

The late Joseph M. Paul, of this city, whose ardent philanthropy 
was actively directed towards the African race, and who consequent- 
ly took a particular interest in every thing calculated to shed light 
upon or ameliorate their condition, undertook the year previous to his 
death, to trace out the particular diseases which occasioned the mor- 
tality of the coloured population. But this tedious task, which con- 
sisted in consulting each individual certificate deposited at the 
Health Office, he was forced by declining health to abandon, after 
completing only one year, namely, 1 827, the tabular view of which, 
showing the mortality for each week, he had the kindness to transmit 
to us. The investigation of the sources of the greater mortality of 

* Accounts of this singular epidemic may be found in Dr. Jackson's paper in 
the Philadelphia Journal of the Medical and Physical Sciences, Vol.1. No. II. 
p. 321, and in Vol. III. No. VI. p. 193, of the same periodical. The disease, 
which was of a bilious and remittent character with typhoid symptoms, made 
its appearance in May, and extended with the increase of warm weather, ter- 
minating" as an epidemic in September. The deaths from it in the Alms-house, 
whither a great many were carried, were about one in six. 



36 



Emerson's Medical Statistics. 



the blacks affords a highly interesting subject, and had time allowed 
we should have continued the labours commenced by our deceased 
friend. But this has not been permitted us, and we are consequently 
obliged to confine ourselves on the present occasion to the results 
furnished by a very limited period, hoping yet to find leisure to ex- 
tend the observations so as to include other years, or to see the sub- 
ject taken up and completed by some other person. 

The diseases comprehended in the statement furnished us, with 
the respective mortality of each, are as follows. The names of some 
with few or no deaths are retained, to show that the proportion set 
down to them in the general bills of mortality, must belong for the 
most part or altogether to the whites. We have adopted the alpha- 
betical order:—. 





No. of 






No. of 


Diseases. Deaths. 


Diseases. 




Deaths. 


Apoplexy - . . 


2 


Brought over 


. 


- 379 


Catarrh - - - - 


7 


Insanity 


- 


1 


Cholera - 


16 


Mania a potu - 


- 


3 


Consumption - - 


92 


Measles - 


, ., ■ 





Convulsions - 


37 


Old age - - 


-, - 


19 


Debility - - - - 


28 


Palsy 


- 


1 


Dropsies - - - 


13 


Small Pox - 


- 


56 


Drowned 


3 


Still-born 


_ 


38 


Drunkenness - 


8 


Sudden - 


-' 


22 


Dysentery and Diarrhoea - 


29 


Unknown 


- 


46 


Typhus Fever 


34 


Various - 


- 


- 143 


Other Fevers - 


89 




» 




Hives - - - - 


, 4 


Total - 


_ 


- 746 


Hooping Cough 


8 


Still-born 


_ 


38 


Inflammation of the Brain 











Inflammation of the Lungs 


9 


Exclusive of Still-born 


708 



Carried ov.er - - 379 

From this view it appears, that of the total mortality of the blacks, 
in the year 1827, namely, 708, exclusive of still-born, the proportion 
from consumption was 1 in 7.6, or 13 per cent.; from fevers 1 in 
5,7, or 17 per cent, which it will be seen, is a much larger propor- 
tion than the deaths from fevers bore to the general mortality for the 
same year, viz. 1 in 10; and from bowel complaints 1 in 15, or 6.3 
per cent. The number that died in the alms-house was 155. 

The actual proportion of deaths for each month is as follows: 



Emei'son's Medical Statistics. 



37 



1. January. - - - 

2. February - - - 

3. March - - . - 

4. April - - 

5. May - 
6.i June - - - - 

When all made equal to thirty-one days, and arranged accord- 
ing to their decreasing mortality, with their respective proportions, 
the months assume the following order:— 



52 


7. July 


- 62 


44 


8. August 


58 


38 


9. September 


63 


44 


10. October - 


- 91 


40 


11. November 


- 103 


55 


12. December 


- 96 



November 
December 
October 
September 
July - 



6. Auaust 



106 


7. 


June 


96 


8. 


January - 


91 


9. 


February 


m 


10. 


April 


62 


11. 


May 


58 


12, 


March 



57 
52 
48 
44 
40 
38 



Of the number 746 actually reported, 401 were males, and 345 fe- 
males, the deaths of females being about 1 in 14, and of females 1 in 
22 of their respective proportions of the population. That the mor- 
tality of males should thus be found to exceed that of the females IS 
per cent, is a result not to have been expected, when it is considered 
that the female portion of the black population exceeds the male 32 
per cent 

The ages or periods of life at which the mortality occurred are as 
follows, viz. : — 

Under 2 years, (still-born excluded) - 190 

Between 2 and 10 - - - - 5^ 



All under 10 
Between 10 and 20 

All under 20 

Between 20 and 30 
«' 30 and 40 ^ 
'' 40 and 50 
" 50 and 60 
«« 60 and 70 
« 70 and 80 
'« 80 and 90 
'^ 90 and 100 
100 and over 



246 



110 

113 

91 

41 

25 

19 

11 

6 

S 



289 



All over 20 



419 



38 Emerson's Medical Statistics. 

The proportion of deaths at particular periods of life compared 
with the general mortality, may be reckoned thus: — 
All underSyr's constitute 1 in 3.7 or 28 per ct. of the whole mortality. 
" 10 " 1 in 2.8 or 34 '<■ " 

" 20 ." 1 in 2.4 or 40 '* '' 

u 30 " 56 " '« 

In concluding our present statistical labours, we would remark 
that it has been our object to supply facts of a general character, ra- 
ther than to pursue details through all their bearings. To have dwelt 
more minutely upon the many interesting topics developed in the 
course of our researches, would, we feared, have overcharged the sub- 
ject, and deterred many from pursuing it, whose partiality for statis- 
tical investigations are not very strong. To those fond of such in- 
quiries we have presented abundant materials and left ample room 
for their employment, as the results we have drawn from the data 
are only the most prominent that presented themselves. We have 
seldom indulged in comparisons with other places, and never with 
our neighbouring cities, our object having been to present facts as 
they exist, whetlier these be favourable or unfavourable to the cha-^ 
racter of our locality for salubrity. Persons who undertake estimates 
for other places, are often led to the commission of errorsy unin,-^ 
tentionally of course, from not being acquainted with some local 
circumstances calculated to affect the results very materially. Such 
causes have frequently led to mistakes with regard to the proportional 
mortality of Philadelphia. We have lately seen with some regret 
a repetition of them in a respectable cotemporary journal, in which 
the population of Philadelphia is represented about 6400 less than 
actually exists within the limits of the bills of mortality.* It is 
needless to add that such an error in the commencement, com- 
pletely invalidates the whole series of comparative estimates. In 
such matters, partiality for a favourite city should never be allowed to 
interfere, and lead to the concealment or palliation of evils where they 
exist. On the contrary, these should as far as practicable be fully ex- 
posed to view, so as to lead when possible, to their removal or cor- 
rection. Without such an application, medical statistics . would 
lose half their value, and instead of being, as it actually is, a highly 
practical, sink to the level of a mere speculative branch of know- 



«^ N,ev»^ York Medical and Physical Journalj Vol, I. p. 436, 



Emerson's Medical Statistics, 



39 



< 






^^ 






.53 









•-ri 


TViOX 


C<> r-l 




00 o 


CO 
in 


< 


•3^ *OGI 1 


*0 -iH 


r-l 


O O j 


b^ 


30T o-\ 06 1 




o> 


o ^ 1 


in 

-CO. 

tH 
?5 


CO o 

06 0^ 08 ^ ^ 


^ 


^ rH 1 


I 00 CO 

08O10Z ^ $0 




O C9 1 




OZ 0^ 09 


11 




^ vj 1 

CO CO 


iO 


09 o; Oi? 


CO r-i 
CO h! 


00 
00 

00 




in 
CO 


09 0^ Ot 


CO VO 

a» o 
(7* ,1 


V5 
b- 




in 


VJ r-l 


^ 
^ 


O 00 

CO CO 




00 CO 


CO 


o *o 




OS 0^ 9\ 


ay vo 


CO 


1-, to 


o 

8 


91OT0T 


'O CO 
CO ^ 




in ^ 

rH T-l 


00 

1^ 

in 

00 


0Xo;9 


00 S 

CO r-( 


CO 


tH T-i 


§ 

g 


9 aspun 


o *n 

O 00 


CO 


tH t-I 


tH 


CO 


■on 'OOT 1 ^ ^ 


T-i 


o o 


CO 


001 oi 06 1 S '^ 


o 


O C>J 


^ 


06 o^ 08 i ^ c^ 


00 


iH CO 


1-1 


1 CO <y> 
08 o; OZ 1 ^ ^ 


o 


io a> 


to 


OZ 0^ 09 


O CO 

CO ^o 


00 

en 


Oi CO 


8 

CO 
1-1 


09 o\ OS 


CO -* 


oo 


uo o 




OS o; 0^ 


o ^ 
00 b- 




a> 00 


«3 

CO 
in 


Of o; OS 


5-S 


00 
CO 


tH tH 


1—1 
to 

00 


OS 0^ OS 


00 oo 

»0 00 


^ 
^ 


T-l CO 


in 


OS 0^ SI 


^ s 
^ ^ 


CO 


CO V5 

lH T—l 


8 


SI o; OT 




V5 

CO 
00 


00 CO 
T-t tH 


^ 
?: 


0X0^9 


i>. 00 
iO CO 

CO Tl 


CO 


in 1-1 
in in 

T— 1 tH 


a». 


9 J9P"ri 


1 00 CO 
O Vi 


T-l 


CO N- 

00 a> 

tH t-I 


1-1 


WARDS 

AND 

DISTRICTS. 


City Wards 

Northern Liberty ^ 
Wards 5 

South wark, and"^ 
other Incorpo- ^ 
rated districts, j 

N. Liberties, un-";^ 
incorporated 5 

Penn Township 





40 



Emerson's Medical Statistics, 



TABLE h.—CONTINUED. 



WARDS 

AND 

DISTRICTS. 


BLACKS. 


TOTAL 
FIITES AND 
BLACKS. 


MALES. 


FEMALES. 


o 


's 

r3 


3 


CO 

o 


V5 

3 


2 




o 


s 


<£5 
CO 

O 


V5 

o 


o 

o 

o 


o 




P 


o 
1076 


1092 


«3 
CO 

695 


V5 

179 


o 
8 


b 


o 




CO 


V5 


O 


h 


^ 


City Wards 


975 


1041 


1872 


1606 


894 


351 


7 


9796 


80458 


Northern Liberty ~> 
i Wards 5 
Southwark, and'^ 


119 


111 


117 


71 


31 





135 


170 


137 


79 


32 





1002 


28923 






























other Incorpo-V 


436 


400 


445 


318 


137 


6 


•446 


546 


538 


288 


100 


5 


S665 


5.3470 


rated districts j 






























;Nc Liberties, un-"? 
incorporated 3 
Penn Township 


12 


7 
20 


10 
14 


6 

7 


3 
5 






9 
8 


' 10 
16 


6 
■ 
13 


10 

9 




7 







72> 
106 


2453 
2507 


1549 


1614 


1678 


1097 


355 


14 


1639 


2614'2300 


1280 


490 


12 


14642 


167811 



TABLE B. 

Births per annum in PJiiladelpMa, from 1821 io 1830 inclusive, with the respec- 
tive proportions of the ^exes. 











Excess of 


Excess of 


Proportion 


Year. 


Males., 


Females. 


Totals. 


males per 
annum. 


males per 
cent. 


of Births to 
Population. 


1821 


2630 


2417 


5047 


213 


8. 


iO^^U- )f. 


1822 


3021 


2701 


5722 


320 


10.5 




1823 


2977 


2836 


5813 


141 


4.7 




1824 


3062 


2771 


5833 


291 


9.5 


1825 


3444 


3182 


6626 


262 


^ .7-Q 


£ S"^ 


1826 


3526 


3219 


6745 


307 


8.7 


^■Sl 


1827 


3581 


3452 


7033 


129 


3.6 


o o o 


1828 


3694 


3506 


7200 


188 


5. 


^ ^o" 


1829 


3638 


So 57 


6995 


281 


7. 


y-^ C"^ 


1830 


3996 


3632 


7628 


364 


9.1 


r+ c ^ 
O 3 X, 


33569 


31073 


64642 


2496 







Emerson^s Medical Statistics. 



41 












S.^ 



"?:;•§ 

'^^ 









o 

Q 


1 iOCNC^CO-^Cni-HCOCNOO 
^ *-^ 1 CN C^ CN (N CO CO CO n C^ CO 


•S91BM 


»n*r>coaicoaiOi:^oooo 

COOiO*OCNCN-*^C<>CO 
CN CN C^ CM CO CO CO CO CO CO 


> 

o 

12; 


t (NCNrHoocooa^'-ia^'O 

•S9IBUI9 J 1 i-(Tj<CNcoinvOOO<00 
^ "* 1 <M CJ C^ O* O? C^ CO CO ^ CO 


1 CT>IvCTiCOO?OOCOTi«b, 

•S9T'Bi;\r 1 coai<ocoi>.30i-iCNt^^ 

"■ ■*•■ 1 CN CN <>? CN CN CN CO CO CN CO 


o 

O 


1 ^OO-^t^OOt^i-lTHOO 

•S3rBUI9,T 1 00CO«3col>.^r^t^C0^ 

*■ "^I^C^C^CNCNCMCOCNCNCO 


*0b-<O<0^OiHV0b-C0 

•sareitf c^o^oi'^Jh-coco'-ii-' 

^ ^ CN C<( C^ C? CO OJ CO CO CO CO 


CO 


1 tN-c^roo^ooOT-Hiocvt^* 
•saT'eiua-T r-t^cot^tococoaiooco 

■• 1 C^ C^ CN CN O? C>:j CO <N C<! CO 


1 t^OiC^O^tOO-r-tCN?'* 


< 


OOCNf^iOOt^'Oi-lcOCO 

^ ^ CN(^!CN(Ncococ^^cocNlc^» 


cNCN-^cococ^'^ooi-iai 

•• '^ C^ (>> CN CN( CO CO C>) CO CN CO 


•-5 


I vOTHO^OCNCOCNOOCTi^ 
^ '^ 1 >-i CN CN! CN CM CN (^} O? C^ CN 


1 aioi:^a>i--N.i^^OTj< 

■• 1 C^ CN CN C^? CN CN C>? CN (>? CO 


<i3 

c 
a 


1 1:^c»o^co»Ot-io^-*^ 
•S9TBIU9,T t^COOr-(co^co<Oco<0 


1 «nrH'.Hiov^i-io%o?ai^ 
•s9Tt3i\r a>^ococoooiocoTf<vo 

^ ■**■ 1 T-i C^ CN C» <>} T-( (>? C^ CN C? 


1 


b,b-tOCOOr-(Tj<ls,tO-^ 
•S9TBUI9 J <Oir-,^a^C^^iot^cob» 


l"*-*^ r-( CM r^ C? CN C^ CO C^? OJ CO 


p. 


1 i^oor-(i-(o<oi^^'oa> 
•sarBUig T l ot^OT-(*ocno:>'OTj<co 

' ^"^ 1 CN r-i C^ C9 O? r-( C>> CN CN C>» 


1 OTHCTi^OcoyDOOOiOO 

•S9TBW OOOCTiC-IOOCO^b-^O-^ 

I "^ 1 r-HCNrHC^C^CNCNC^^C-^CO 


i 
^ 
S 


1 <oc>?i-(co^i-i^incNC9 
I '^l(^(c<fc^^c<^c^o^cocococo 


•s9iieK 


Tj'iOCOCOO'^C^iOC^TH 
CNC^CNCMCMCOCOCOCOirO 




1 OT?ooo?a>cs!tv.aiV5co 

=»^l ^ ^ 1 ^ c<t ^ C^ (M C> C^ OJ CO CO 


O^O^O^VOOiOCO 
^ *^ C^ <M CM <N CN( C9 CN CO CO CO 


>-9 


1 b-O^OOOr-tf-^OKCO^ 
^ '^ICNCSfCNCNCNC^O^COCNCO 


*o tv, en a> 00 lo 1^ CN o o 

^ ■*' CN CN (N C^ C^ CO CO CO CO CO 


•sayaA 


T-ics(co^»o^oir^coaiO 

CNCNCNC<?CNC~}C^C^C^CO 
00000000000000000000 



No. XVII.—Nov. 1831. 



42 



Emerson's Medical Statistics, 



TABLE D. 

An estimate of the proportion of Deaths in the City and Suburbs of Philadelphia 
to the Population^ from the year 1821 to 1830 inclusive, showing the rate for 
each year, together with the average of the series. Note. Still-born excluded. 



Year. 


Annual 
Mortality. 


Population for 
each year. 


Proportion to 


Population. 








one in 


per cent. 


1821 


2961 


124934 


42.19 


2.37 


1822 


3334 


129253 


38.76 


2.57 


1823 


4372 


133721 


30.58 


3.26 


1824 


4284 


138343 


32.29 


3.09 


1825 


3539 


143126 


40.44 


2.47 


1826 


3845 


148073 


38.56 


2.59 


1827 


3659 


153300 


41.89 


2.38 


1828 


3971 


158488 


39.90 


2.50 


1829 


4001 


163960 


40.99 


2.44 


1830 


3948 


169536 


42.94 
10) 388.54 


2.32 


25.99 


A 


verage mortal 


ty per annum 


38.85 


2.59 



TABLE E. 

dn estimate showing the respective Mortality of the White and Coloured portions 
of the Population of Philadelphia, from the year 1821 to 1830, inclusive, exhi- 
biting the proportions in each year, and the average for the whole period. Still- 
born excluded. 



Year. 


Annual Mortality. 


Population for each 
year. 


Proportion of Deaths to 
Population, as 1 in 




Whites. 


Blacks. 


Whites. 


Blacks. 


Whites. 


Blacks. 


1821 


2320 


642 


114065 


10869 


49.1 


16.9 


1822 


2813 


521 


118008 


11245 


41.9 


21.5 


1823 


3612 


760 


122088 


11633 


33.8 


17.5 


1824 


3598 


686 


126308 


12035 


35.1 


17.5 


1825 


3078 


461 


130675 


12451 


42.4 


27.0 


1826 


3353 


492 


135191 


12882 


40.3 


26.1 


1827 


2954 


705 


139963 


13337 


47.4 


18.9 


1828 


3314 


657 


144700 


13788 


43.6 


20.8 


1829 


3400 


602 . 


149696 


14264 


44.0 


23.7 


1830 


3405 


543 
A 


154737 
verage of th 


14799 
e ten years 


45.4 
423.0 


27-2 


217.1 


42.3 


21.7 



Emerson's Medical Statistics, 



43 






CM 
CO 






.« 
^ 
^ 

•^ 



S 



§P 





•suoispAuoo 


CO ^ a^ <o 

O ^ 'O o 

C^ CO Csf CO 




•suoi;i3aiui^tJ"I JO I^^OJL 


tc CO T-^ in 

CO CO CO o 
^ ^ VO V3 


.2 

1 

C 


•11 
11 


•si^^ox 


(N Cr> 00 c^ 

in CO o^ 00 

y-t T-t T-{ T-i 


•snj9;n 


O r-l ^O tH 


•jgpp^ia 


T? 1-1 fN If) 


•sX9upr\i 


O TjH o o 


•U99ids 


T-l O O 1-t 


•.i9AtT: 


,-H C^ (N *0 

tJ< CO ^ C^ 


•uin9uo:H.t9tI 


t^ CJ^ i-H OO 
i-H CN i-H 


spA\oajo -uiByui 


O^ lO i^ CO 

a> CN c^ CO 

rl tH tH 


Inflams. of Or- 
g^ans of Respira- 
tion and Pleura. 


•sixi^ox 


t^ ^ CO Tj. 


•qj.re;^0 
•si:^iipuoag 


^ cr^ o o 

00 '^ O CO 
CO 1^ b- o 

CO CO CO ^ 


•Xsumaiti 


oj lo o a^ 


•sSunq JO "uiT^yui 


CO CO CT> a> 


> 


•laj.reos 


^00.0 


•oipaH 


^ CO ^ iO 


•[■Bjadaand 




•SJ9A9J 

SuToSajoj 9\\i JO s^^iox 


in CO o CO 
to 1^ «o c^ 

CO CO CO CO 


•pa^BuSisapun, 


113 

118 

1 j 73 
1 71 


•4UBuSii^K 


•s;u3niui'i9iui 


^ r-l CO O^ ! 
1-1 CO i-H I 


•snoAa9jsi pu^ snqd^x 


^ Cn yD CO 1 
O iO o <o 1 

T-( j 


•ijoi^mui^yur 


iH CO CO ^ 


•:^u9;:^iui9a pu^ snoxitg 


CO CO <0 tH 
CO b- O 00 

r-l T— ( 1— ( 


i . 

U -;-J 


■si^noj, 


-* CT. ^ rH 

oo c^ o^ to 

CO '^ CO CO 


•^J9; 
'U9S^(I pu^ ijnoqjai3ia 


^ a> K »o 

'^ CO CO c^? 

rH T-H tH tH 


•■BJ9[oqo 


O^ O b- to 

CO cr> lo CO 

CO C^ CO c>? 


•uoT^duinsuoQ 


CO 1-1 CO to 

CO CO CO CO 

lO >o to to 




•u.ioq-imS 


to 1-1 CO CO 
OD CO CT. O 
C-? CO C^ CO 


'uaoq-|p:^sjo SAisnpxa 
umuiiB jad X;T^^4Joai sioqAV 


Oi T-l 1-1 CO 
V5 Jv, O ^ 
to Oi O CT) 




•SHVaA 


b- CO ':3^ O 
CO O? C^> CO 
CO 00 00 OD 

tH 1— I 1— i T-i 



44 



Emerson's Medical Statistics, 






< 



•p9u.Y^oja ^^^q^ 



•SDr+t^nsBo g^Sg]^ 



Hi^qdy 



•SU0109fJ tJUlSuy I O lO -* CN 



•lusunauy | ^r^co y-^ 



•paqpitqO 



00 CO -^ 



•spioing j T? b- CO tv. 



•snuB^aX I S 



o -* o^ yD 



ijiqdXs 



•uisi;t;Lun3i|y^ | -^ co <o co 



•Asdapda I S ^ 



•oi[03 I ^ ^ S 



"BUiq^sy I ^ ^ 



CS> O O CO 

t H t- I tH 

^ CO ^ "^ 



snqijpg puB asouijo 



•spui5[ 
||B JO saS^ijajouiseH 



•spfi^oS puB siung 



•^Boaqx 9J0S | '^ ^ ^ ^ 



•uop^oijt; 
-joi\[ puB auaaSui3Q 



•SniUSBJBJ^ puB 

*s9qi3x 'iqdoj^y 



•S3tS133I\[ 



•U9ppns 



•i{x3{dody 



•qSnoQ SuidooH 



•dnojQ 



•xod n^mg I o o 



•agr? pio 



X\3D3Q[puT3 X^qiqsQ; 



t^ 00 to to 

CO. CN to o 

(N o 00 (>( 

CN) CO CN! CO 



•F^ox 



I en CO b- CQ 

I th in CO 00 

I CN| CM O) C^ 



•ps^TJuSisapuQ 



•isaqo 



•pT59jjjo Xsdoao; 



(M r}< ^ -^ 
h~ O 1^ CN 

O tH Tfi iO 



•suvaA 



r^ 00 en o 

CN CN C^) CO 

00 00 00 00 



•SUIJO^\^ I T}< T}* ^ T7« 



•pIO[0]aBA O l^ CO r-l 



'UAVOU^lUfl rH 1>. CO K 



•spunOj^^V CN -^ CO CO 



•aOU9^0TA 



1-4 CO tH CO 



•sa9ojn 1 ^3 S ^ 



•Su!q;99x I 



•sanomnx 1 2 iJn 



•EpqigBUidg I CO CO o 00 



•{9A'B.lf3 pUB 9UO;g I CO CN CN CM 



•BiTijoaoslg^^SS 



•SU9|0Q[ mSBUlS9[qtI j iH iH O (M 



•SS90 

-S9 o; uinu^pn^JT; 



CO Ci O «3 



•Xsi^j 



rH iH ■* <0 
CO ^ ^ CO 



•90ipunBf I 00 O O 00 



•iC:;iuBSUi 



••BIUJ9H I ^ -=? ^ 00 



•:^t\09 I '^ <o ^ ^ 



•S9p 



•pTf39C[ pUt^OJ[ 



'BTsdgds^Q I b- CO -^ th 



-d!H 



JO 9SB9SI(J 



•9.irHOT3JJ I V5 00 Tfi >0 



's^pdisXag 



•suoi^dnag 



•9Uldg 

9q^" JO 9SB9Sia: 



9q:^ 



•)aie9H 

JO 89SB9STQ 



CM O Oi to 
rH C<J CM CM 



j9;yM p[oo Siiiiquijp 

piTB :^B9q 9AISS90Xa 



pUB SS9UU95[Uma 



•n;o J B TJiuBj^ 



•SS9UU92[Un.TQ; 



CTi CM t}* lO 

to Oi en 

CO O ''^ V) 

V5 CO CO CM 



■SHV3A 



i^ 00 Ch o 
CM CM GS> CO 

00 00 00 CO 



Emerson's Medical Statistics. 



45 



pq 

< 



O !< 



Si 



Si « 






1j 



"^ CO 

^S3 



•SrH 



^ ^ 



•9S«J9A"B pu^ 

jB9Xqo^9aqj 
9JI]; JO uoi; 
-Kinp UB9IV 


rHr-lOOiHCNJCOr-ltO^ 

diHyfodoJo^ootCtvliv: 

COCOC^CNC^CNCMCNCSJC^ 


CM 


•ujoq-ni^sjo 

9ATSnpX9*UB 
J9fIsq;B9pjO 

•OM aioqAV 


ocoi>-ooco^»ol>-o-^ 
o^cococ^iocotoa^ooj 

CS> CO '^ ^ CO CO CO CO -^ CO 


CO 


OSI Pu« OTX 
u99Av;9g: 


OOiHOOiHOCOOO 


to 


Oil Pu^ 001 

U99M19a 


r-<^COCO'*l^'=?CNCNCN 


CM 

CO 


001 pu^ 06 

U99M19g 


C^tHCMCNCNCOCMi-ItMCN 


CN 


06 Pu^ 08 

U99A\}9a: 


■r-iN.toi>-»ncot^o*oo 


1> 


08 P«^ 01 

U99AV;9a 


lvOb~h-C^*0T-(OC0O 

O^ CO CO ^- CM CO CO *0 <0 r-l 


CM 

CO 


01 Pu^ 09 

U99AV19a 


tHCNCSJCNtHC^tHtHCMtH 


CO 
CO 

1— ( 


09 P"^ 0? 

u99An9a: 


CN ^O T-1 O <0 b- «0 O O <0 
C^ CN qpco CN) C-^ O? CN CM CN 


CM 


0!? pu^ 0^ 
u99Avi9a: 


-* 00 (>> iO CO O -* C<{ CM CO 
CNf^tOcot^CO^b-^iO 

CO CO ^ ^ CO CO CO CO CO CO 


CO 

CO 


Of puTJ OS 

u99Ava9a: 


OTH<O^OCTi(>>iOC7>b-00 
Oi'^COCOlt^^THiOCTJTH 

co^>o^^^^^^^ 


s 

^ 


OC puB OS 

U99AV:i9a: 


iO^lr^CT^CMCTi^COtv-OO 
O O CO O CO O? ^ C^ 1^ o 


CO 


OS P«^ ^T 

U99AV:i9a: 


00 o T-i c) c? CO 00 CO CO Oi 

OOOiiOtOOOCMCNr-IOai 
iH 1— 1 tH tH rH tH 


1— t 


^T pu^ ox 
u^9Av:^9a: 


OC0-r-IC0 00»O^O!>.*O 




ox Pu^ S 
U99iV^:^^g 


CMi-H^i-lOOTj^rHOOOOCTi 
O C>:! 00 Cs> CM CO CO tJ< lo CO 
tHtHtHCM-i— ItHtHtHiHtH 


tH 


9PU^S 

U99A\;9e: 


C0C0CT^-*CN(i0V)CTiC0O 
CT^OiCTi^OCOOOT-ICMOO 
tH rH CO CO CM CSJ CM CO CO CM 


to 

CM 


SpuB X 

U99A\;9a 


10C0tH-*OOC0»0^V5 
TH-^OCOiOOOOiCTitOCM 
CMCM^COCMCOCMCOCOCO 


o 

iO 
CM 

CO 


J^9i{ X 

J9pun 


co^-^^oo^ocoinco 

COOilOCOCO^V^cO^OO 

<o^oocrioooooocnG^o 


00 


Years. 


iHCSJCO^^Oh^OOCTiO 
CMC^CMCNCMCMCMCNCMCO 

000O0O0OCX5000OO0COO0 





46 



Emerson's Medical Statistics* 















5^ 



5 


OS P«^' ^ 
u^^A\:^9e: 


^S2^g^ 


CM 

o 


CO 
CM 

<o 

lO 


p 
o 

PQ 


o 
o 

p 


OS pu^ ;? 

U99AV;9a 


c^ o a o -* 

C^ CO C^J CO CM 


in 
CO 


< 


u93M:^3a; 


00 b- T-( V) o 

tH T-H r-t r-l CM 


CO 


C^pUTJg 
U93AVpa 


C7^ »0 CM CO V3 
tH G-} CM CM CM 


S 


SPu^T 

U99A\;9a 


^ i^ O ^ 00 

CO CN Tf CN) Tl 


■r—^ 


SPU^X 
U99AV;9a 


S3S^1?5 


o 


•aB9X X 

j9piin 


O ^ ^ b- r-l 

VO O tH t-^ CO 




•jBgX X 
jgpufi 


th ^i>. lo cr^ 
rf >o to lO Vj 


C7i 

to 

CM 


1 


OS P"^ s 

U99An9e: 


<o Tjf a> CO ^ 

CN r^ tH CN( CN> 


r-l 


£ 
> 

Q 


OS Pu^ 9 

U99A\;9a 


V> CO CO >0 G<> 
CM CO CM (>^ 0< 


CM 


OO 

in 


9PU«S 


tH »0 00 V5 00 
CO T-( rH CN tH 


'§ 


9 P"^ S 

lI99A\:t9a 


iO ^ -^ O b- 
TH CM CO CS> rH 


O 
rH 
rH 


SPu«I 

U99M59a 


V5 VD K Oi-rH 
CN) rH T-l C^ i-H 


00 


S Pu^ I 

U99A\q,9g: 


Ol V5 O »0 00 

tH tH CM tH tH 


b- 

CO 


•aT39X X 

jgpun 


Ol O? lO CO tH 
CO CO V5 «jD VO 


O 
CM 


•a^9i X 
•lapun 


b- ^ -* CM CM 
t:J ^ to *0 *0 


05 


< 


OS Pu^ 9 
u99M;9g: 


0© V5 Ol V5 tH 
CN CN tH CN C<> 






o 
o 

o 


OS P"^ 9 

U99AU9g: 


CM -^ tH to O 
CO CM -* CO CM 


CO 
»n 

rH 


tH- 
CM 


ppUBg 
U99AV:i9g 


O ^ O ^O V5 
CO rH (r9 CO 1-1 


c>? 


9 ptiG s 

U99AV;9a 


CO CO tH lO W^ 

CM rH CO CM T-t 


b. 

rH 
rH 


Spui^x 

U99A\;3a: 


^£3 CO CO »0 b. 
CO -M tH i-H tH 


o 


S PU13 I 

u99M;9g 


■M rj* ^ VJ CO 
CM tH CO CM CO 


b. 

CM 

TH 


MB9X X 

J9pun 


a> -* t^ V5 o 
Oj »o CO b^ <o 




MT39i{ X 
, J9pun 


CO T-l ^ ^ C^ 

■^ to to CO b- 


CO 


1 


OS pu^' ^ 

u99Av:;9g 


vo CN( in CO c^ 

CO iH C^ CO CO 


00 
CO 

tH 


tH 

o 
b- 


u 

0) 

s 

CD 
C/2 


OS pu« ;? 
ii99.w:^9a: 


O C7i J^ O CO 
*0 CM ^ CO CM 


b- 

tH 


en 

00 


INPUTS Z 
tl99AV:^9a 


CO ^2 00 00 b. 

CO tH tH CO tH 


CM 


9pUT3 2 
U99A\:i9g 


1-1 CM O C^ T-f 
CM CM CO CO CO 


to 

CO 


SPU^ X 

U99AV;9a: 


r-i 00 ^D CO y:> 

CO tH T-( C^ CN 


cr. 

tH 


g puB X 

U99M;9a 


in CO o o w 

CO CO ^ to ^ 


3 


•Jt'9/C X 

a9pun 


CO ^ o »o ^ 


CM 

CO, 


•JB9i{ X 
J9pun 


tH 00 CO i^ to 

V5 *n t^ oi 00 


in 
to 

CO 




OS PU^ S 

U99AV:i9a 


T-i CO CO CO ^ 

CO rH C^ C^ CM 


C7i 

T-l 


^ 

fe 


CO 


OS P"^^ 9 

U99AV^9a 


in CO ^ b- -^ 

C^ ^ CO CM CO 


2 

rH 


00 
rH 


9 pu^' S 

U99AV19a: 


cr^ CN CO CO iH 

CN CS) CM CN CM 




9 puBg 

U99A\;9g 


:s:5^^s 




S P^i^ I 

U99AV;9g 


O CO r-l T-t CO 
CM CM T-l C-:) rH 


CT> 


SpuB X 
U99m;9a 


in b. th o^ v) 

An :^ b- i^ to 


b- 

CO 


•xe^i X 

j9pun 


CM -* r^ <M t^ 

b, 1>, VO t^ o 


to 

CO 


vre9-{ X 

.T9pun 


»n T-( otro b- 

O O O CM rH 


in 


1-5 
t 


OS P"^ 9 

a99A\a9a 


(!>■) th CO a> '^ 

O^ C^ CM i-( CM 


CTi 
O 

l-H 


CO 

b- 

c5 
S 

Eh 

<u 




OS P"^ 9 

U99A\:^9a 


rH o to 00 in 

CM CO CM r-l CM 


tH 


CO 

6 
£ 

O 

h 


9 pui5 s 

U99AV;3a 

S pui^ X 

U99A\;9a: 


'^ CO CM '^ ■* 
iH rH <r^ CM CM 


§ 


9 P"^ S 

U99A\;9a: 


CM C>) CM -^ b. 
CO CM CM rH CM 


b- 

rH 
rH 


^ en Tf b. b. 
tH r-t tH T-H tH 


1—1 

00 


SPU^T 

lI99AVpa 


CO to in -* rH 

to CO to CO *n 


CM 


•JB9A X 

J9pun 


CTi rH O Oi CM 
-^ iO to iO o 


CO 
CM 


•.TB9X X 
J9pun 


b- o in in c7^ 

in in C7> CO C7> 

T-H rH tH tH rH 


to 


•S^V3A 


to b- 00 Oi o 
C^ CM CM CM CO 
00 CO 00 oo oo 




•SHVaA 


to b-OD CTi O 
CM CM CM CM CO 
OO 00 00 00 00 
y-i y-i ^ y-^ -r-i 





Mott's Case of Immohility of the Jaw, 47 



Art. II. Case of Immohility of the Jaw and Taliacotion Operation. 
By Valentine Mott, M. D. &c. &c. [With a Plate.] 

On the 7th of April, 1831, I was consulted in the case of Miss 
Marj Park, aged seventeen, of Southbridge, Massachusetts. 

Her attending physician. Dr. Samuel Hartwell, gave the fol- 
lowing relation of the case. <'In the autumn of 1822, she had an at- 
tack of typhus fever: the symptoms were mild in the commencement 
of the disease, and nothing unusual occurred until the middle of the 
third week, when tumefaction and redness were discovered on the 
kft cheek, accompanied with slight delirium and general aggravation 
of fever. 

" At the end of the third week, a dark vesicle, about the size of a 
pea, appeared at the angle of the mouth, announcing the existence of 
sphacelus, and in a few days extended to about two inches in diameter 
upon the side of the face. A crisis of fever now supervened, which 
was followed by sloughing of the whole gangrenous portion, leaving 
the teeth and gums exposed. Upon its cicatrization the jaws remain- 
ed immoveably fixed, being apparently tied together by a ligamen- 
tous band within and about the cicatrix. Her food was introduced 
into the moujh through a space formed by the removal of a tooth on 
the right side. The first set of teeth and the alveolar process of the 
diseased side, were detached by caries. Most of the second teeth 
were developed in. a few years afterward. 

" No mercury was used in the treatment of the fever. Her gene- 
ral health is now very good." 

Her countenance was much disfigured, and presented the appear- 
ance represented in Plate I. fig. 1. 

As the only means of permanently overcoming the closure of the 
jaw, was the removal of the cicatrix, I determined upon excising and 
replacing it by sound integument from the face and neck. 

Accordingly on the 8th of April, assisted by Dr. Vache, and in 
the presence of Drs. Hartwell, Barrow, Wilkes, Hosack, and 
several others, I performed the operation. 

It was commenced by carrying an incision from a little within the 
upper angle of the mouth, around the outer margin of the cicatrix, to 
a little within the lower angle of the under lip, and by the immedi- 
ate removal of the newly-formed parts included within it. The adhe- 
sions between the jaws were next divided, which enabled me in con- 
sequence of the relaxation thus produced, to insinuate between the 



48 Mott's Case of Lnmohility of the Jaw, 

teeth of the opposite side, the point of the lever used in my former 
cases, with which I finally succeeded in opening the mouth. 

This point accomplished, the lips were brought together at the an- 
gle of the mouth by a suture, and I proceeded to detach a portion of 
integument sufficiently large and of corresponding shape to replace 
the part removed. See dotted lines, Plate I. fig. 1. It was turned into 
the space it was intended to fill, leaving a tongue three-quarters of 
an inch in breadth, connected with the adjacent part and sufficient 
for all the purposes of circulation. The cut edges were adjusted 
with extreme accuracy, by means of interrupted sutures and adhe- 
sive straps: the lower wound was contracted as much as possible by 
adhesive plasters, and the whole covered with lint, compress, and 
bandage. 

Previous to the operation she took sol. sulp. morphine, double 
strength of Majendie's formula, gtt. xiv. The operation occupied 
about an hour, and was sustained with a firmness peculiar to the fe- 
male sex. 

Evening, — Had been sick at her stomach, and vomited some co- 
agulated blood, which had no doubt been swallowed during the 
operation. 

Spril 9th. Found her sitting up at the side of the bed. She felt, 
she said, very comfortable, and had passed a good night. Hardly 
any perceptible swelling of the face. As far as the parts can be seen 
all looks favourable. Ordered her a dose of sulph. magnesias. She 
can depress the lower jaw, by the effort of the will, to the extent of 
about half the width of the finger. I advised her to continue the mo- 
tion of the jaw, from time to time, as much as the soreness at the 
angle of the mouth would permit. 

10th and 11th. Continues to do well. 

12th. Some little tumefaction under the eye, but she makes no 
complaint. Directed an emollient poultice to the hard dressings 
upon the wounds on the neck. 

ISth. Several poultices have been applied to the neck, which have 
softened the lint^ upon carefully removing it and the plasters, the 
wound was again dressed in the same manner. 

14th. Complains of a little head-ache from not sleeping well last 
night. Felt great comfort from the removal of the stiff dressings 
yesterday. Bowels are in a good state. Cannot say to what the 
head-ache is to be attributed j she thinks it owing to the loss of sleep 
last night. The swelling of the cheek has subsided. Changed the 
lint again to day. 



Mott's Case of Immobility of the Jaw. 49 

I5tlu Found her in bed this morning, with pains in her limbs 
generally, and with some swelling of the right knee, and tenderness 
to the touchy passed a bad night; her pulse is much more frequent 
than natural. Is not aware that she ever had rheumatism before. 
Directed general and local treatment for her disease. She makes no 
complaint of her face, which in all respects is very promising. I re- 
moved three of the stitches from around the angle of the mouth, and 
reapplied lint and plasters. 

IQth. Still in bed. Has less pain and swelling in the knee, but 
more in the foot and ankle; generally she feels better. Removed 
another stitch from the lower part of the patch. The wound of the 
neck looks well; dressed it with ungt. resinse and plasters. 

17t1u To-day she is generally better, but feels most pain and ten- 
derness in the knee and ankle of the other leg. Says her face feels 
very comfortable. I removed three stitches from the upper part of 
the patch, and for the first time all the plasters, and washed the 
whole surface. Adhesion seems to have taken place at every point 
of the flap. Dressed the face as yesterday. 

18^/i. Every part of the flap appears to have united. Dressed the 
wounds with dry lint. Advised her to move the lower jaw a little 
downward, every day several times. The rheumatic affection is 
seated in the right wrist and fingers. Ordered the use of tinct. 
colchici. 

19/7«. Passed a better night; but both arms are now nearly useless. 
Consented to day to be bled. Repeated the infus. sennas as a ca- 
thartic; dressed the face, which looks very well. 

9.0th. Feels generally better. Both arms still much affected. Drew 
the edges of the wound in the neck together with adhesive straps. 
Directed the tinct. colchici to be increased. 

21st. In all respects better; a slight rheumatism yet continues in 
the left hand and arm. The colchicum has produced some cathartic 
action on the bowels. I dressed the face and wound as yesterday; 
directed her to open the jaw more frequently; and to continue the 
colchicum. 

22f/. Found her sitting up, and says she is more comfortable. 
The left hand and wrist still a little tumefied and painful. Face 
and wound continues to improve; dressed them as yesterday. Has 
more motion in the lower jaw. 

23J. Is free from all pain to day, and feels quite well again. Or- 
dered the colchicum to be discontinued. Dressed the wound as before. 

9,5th. Continues free from rheumatism. The wound improvesj 
and was dressed as yesterday. The jaw moves more freely. 



50 Mighels's Case of Immobility of the Jaw, 

May 12fh. Patch in the cheek entirely healed, (see Plate I. fig. 2,) 
The wound in the neck is nearly closed. She can open the jaws 
sufficiently wide to admit solid food. 

14th. She leaves town to-day in good spirits, and delighted with 
the result of the operation. 

Although I have before often operated for immobility of the jaw, 
and with the happiest results, and have once removed a deformity 
occasioned by a hole in the cheek, by the Taliacotion method, in the 
New York Hospital, with perfect success, I have never before seen 
it necessary to combine both operations in one individual; and the 
gratifying termination of this long and arduous case, is a convincing 
proof of the excellence of the means employed, and of the power of 
art in repairing the ravages of disease, and in relieving its distressing 
consequences. 

25 Park Place, New Fork, 

N. B. A letter was received from Miss P. by the lady with whom 
she resided here, in which she stated her health to be excellent, the 
jaw to have acquired increased motion, and her friends much pleased 
with her improved appearance. — July, 



Art. III. Case of Immobility of the Jaw, successfully treated hy 
Professor Motth Complicated Lever, and a Modification of hi» 
Operation, By Jesse W. Mighels, M. D. of Maine. 

In June last, J. T. of Hebron, Oxford County, aged twenty, called 
on me for advice. On examination I found that his under jaw was 
almost immoveably fixed to the upper, by a firm, ligamentous adhe- 
sion, extending from the cuspidatus tooth on the left side, backwards 
to the coronoid process. There was no lateral motion, and but a 
slight motion downwards. His face was badly disfigured, the left 
cheek being much fallen in, and the mouth drawn towards one side. 
Being able to separate his front teeth a little, he had conveyed his 
drinks between them, and by using them in masticating small por- 
tions of solid food, had worn away the upper incisors so as to leave 
an opening of nearly a quarter of an inch. 

, He* had been in this situation ten years; said it was occasioned by 
'tt'eglected mercurial ulceration of the cheek and gums. He also in- 
formed me that it had been cut five times by eminent surgeons — twice 
by the late justly celebrated Professor Smith, who, by the use of a 



Morton on the Adaptive Powers of the Eye, 51 

wooden wedge succeeded in separating his front teeth about half an 
inch, but that it irresistibly contracted as the wound closed. On 
the whole, the case too nearly resembles the one related by Professor 
MoTT, in No. IX. p. 102 of this Journal, to need any further descrip- 
tion. I proposed the same operation as there described, but the pa- 
tient objected to having his cheek cut through. I therefore varied 
the operation so as to save the cheek entire, and am induced to be- 
lieve that this is an improvement worthy of notice^ for, independent 
of its saving at least some pain, it leaves the face free from scars, 
and there is no danger of the breaking of stitches and slipping of ad- 
hesive straps during the cure. 

The patient being seated in a chair in a strong light, his lips sepa- 
rated and firmly held by assistants, I passed a very sharp two-edged 
knife, flatwise, in the direction of the teeth, back to the angle of the 
jaw, and carefully dissected the morbid adhesion from the gums; I 
then turned the edge so as to cut through the hardened mass cross- 
wise, and as far back as I could. This so far loosened the jaw as to 
admit the vice betwixt the first molar teeth, and I then expected that 
a trifling force would be sufficient to finish the operation, but I have 
no doubt that the force applied was equal to one hundred pounds, 
and when it yielded it was attended with an audible crash resembling 
the laceration of ligaments. By keeping the jaws asunder by a wooden 
wedge, and the cheek from the gums by a soft sponge for a few weeks, 
the patient completely recovered the use of this jaw and the natural 
shape of his face. 

Minoty Maine^ June, 1831. 



Art. IV. On the Maptive Powers of the Eye. By H. Morton, 
M. D. of New York. 

1 HE functions of the organ of vision have engaged the attention of 
anatomists and physiologists to a greater extent than any other organ 
in the animal economy. Its general anatomy is sufficiently well un- 
derstood, but its physiology, we are inclined to believe, has not kept 
pace with the general advancement of medical science. Its func- 
tions as a dioptical instrument, or an organ of vision, offers a consi- 
derable field for observation and experiment, and a more accurate 
knowledge of these functions would perhaps enable us to explain 
more satisfactorily a great variety of its phenomena that are now ob- 
scure. Such knowledge might also enlighten us on its pathology, both 



52 Morton on the Adaptive Powers of the Eye. 

surgical and clinical, and as it is the organ through the medium of 
which the mind acquires by far the greatest proportion of its ideas, it 
might not be without its influence in a metaphysical point of view. 

We find in the human species, as well as in most of the lower 
orders of animals, two organs of sight, but which, as regards the 
function of vision, should nevertheless be considered as one single 
organ; their analogous distribution of nerves and muscles, their per- 
fect unison in motion depending upon this distribution, the necessity 
there seems to be that objects should be painted upon the same rela- 
tive part of the retina of each eye, appears to indicate that nature has 
constituted them one organ. Whether this unity of function could 
be extended to the microscopic eyes of insects, our present know- 
ledge of comparative anatomy will not permit us to decide.* In the 
human subject, however, it is evident. 

The general phenomena of vision is sufficiently well explained by 
the present known laws of optics. It is known that rays of light 
proceeding from objects or bodies, after passing through the different 
humours of the eye, and having undergone certain changes as re- 
gards their direction and colour, are received upon the retina or ex- 
pansion of the optic nerve, and there form an image resembling 
the object from which they emanated | the image, however, is 
much smaller than the object, and inverted. These facts are 
sufficiently proved by the examination of the recent eye of an 
animal, and also by instruments constructed to resemble the hu- 
man eye; but upon examination we will find that the eye, how- 
ever recent it may be, has lost its adaptive powers,t and optical 

• Our own organ may be rendered microscopic by substituting' for the natu- 
ral pupil, (which cannot be broug-ht to the requisite degree of minuteness,) an 
artificial opening. If a piece l)f card be perforated with an ordinary sized pin, 
and vision directed through it, distinct vision of minute objects may be obtain- 
ed within half an inch of the cornea. We find nature has adopted the same 
mechanism in the formation of the eyes of the chamehon; it feeds upon minute 
insects, and its pupil is so small as to be scarcely visible to the naked eye. 
" La fente est d'ailleurs si petite qu'on voit a peine sa prunelle au travers." — 
Cuvier, Anat. Comp. d'CEil. 

f The observation of M. Majendie upon the dead eye of an animal is equally 
true of the camera obscura; in fact, the recent eye is no more than a perfect 
camera obscura, and in both cases the distinctness of the image will be increas- 
ed by adapting a pupil of the requisite diameter, and supposing the image on 
the retina of the recent eye is equally distinct when directed to near and dis- 
tant objects, yet as we are ignorant of the precise degree of distinctness re- 
quisite for vision, no certain inference could be drawn from this fact. If the 
same thing occurs in the living eye that M. Majendie and others have observed 



Morton on the Jldaptive Powers of the Eye. 53 

instruments we know must undergo certain adjustments for their 
proper adaptation. In both cases the focal distance of the lens must 
be changed, either by motion in itself, which is a theory advocated 
by many — or else its relative position as it regards the retina must be 
altei'ed-— or^ which is equivalent, the retina or screen upon which the 
image of the object is received, must either approximate or be re- 
moved further from the lens, according as the object viewed is nearer 
or more remote, unless the organ or instrument be adapted for pa^ 
rallel rays. It is presumed that there is a mechanism by which the 
animal eye is thus enabled to adapt itself to points of vision at dif- 
ferent distances^ yet there are some ingenious men who can see no 
necessity for this power and would explain the function as the result 
of habit and attention. Notwithstanding, however, the subject has re- 
ceived a great deal of attention, and a great many truly ingenious 
and interesting experiments have been made, they seem to have 
tended rather to expose the errors of other theories than to establish 
the true one. 

The eye is unquestionably the most complicated organ in the 
whole system, and therefore an explanation of its functions ne- 
cessarily demands an intimate knowledge of all its complicated 
parts| not merely the general laws of optics applicable to it, but also 
its minute anatomical structure, as well as the physiological sympa- 
thies existing between its different parts. To consider the eye as a 
mere optical instrument, or even the most perfect *•' camera obscura," 
which it certainly very closely resembles, would by no means lead 
us to an accurate knowledge of its general functions, and least of all 
the peculiar function we are now considering. 

In comparing the eye to any optical instrument made to re- 
semble it, we should conclude that the skill and power which form- 
ed the one, endowed it with properties which it would be absurd to 
expect to find in the other. Omniscient skill and Omnipotent power 
was exercised in forming the human eye and adapting its various 
parts to harmonize in action, while the optician's instrument, how- 

in the dead, that is, all objects, whether near or remote, are equally distinct in 
outline upon the retina, where will we find an explanation of the fact, that in 
vision near objects are actually more distinct than distant ones. It seems only 
to increase the difficulty, whereas, if we admit that near objects are rendered 
more distinct by a certain adaptation of the eye, (which can be proved even on 
the recent subject, by making use of a diaphrag^m having" an opening" of the 
requisite diameter,) we at once can account for the different distinctness of 
near and distant objects. 

No. XVII. —Nov. 1831. 6 



54 Morton on the Adaptive Powers of the Eye, 

ever perfect it may be, is, after all that human ingenuity can suggest, 
but an imperfect imitation of its model. 

Among the variety of opinions entertained respecting the adaptive 
powers of the eye, that appeared the most satisfactory at the time, 
which supposed an alteration in the spherical form of the eye pro- 
duced by the action of the recti muscles, whose consentaneous action 
either lengthened or shortened its axis. The great and permanent 
convexity of the cornea in near-sighted persons seemed to favour this 
idea, and it was inferred that a palpable motion productive of this 
effect would be detected upon examining an eye while in the act of 
adapting itself to points of vision at different distances. Experiments 
were therefore made to establish this fact^ the eye of an individual 
was observed through a microscope in such a manner that the slightest 
motion, if any, would be detected, but no motion adequate to the 
requisite effect could be observed. Neither could it be fairly inferred 
that the great convexity of cornea in near-sighted persons was the 
cause of their defect of vision, for in the ingenious experiment of 
Dr. Young, the eye, (although the influence of the cornea was de- 
stroyed,) still retained its adaptive powers. That a very great de- 
gree of convexity in the cornea would be attended with a certain de- 
fect, as it regards the adaptive power, is possible^ such miglit be the 
case in congenital malformation; but it can scarcely be considered as 
the cause, when this defect is consequent or depending on constitu- 
tional derangement, too violent or long-continued action of the organ, 
or when the eye has been subjected to too intense a degree of light, 
or even in sudden transitions from one medium of light to another, 
when the e^^e, at least for a time, loses its adaptive powers. Cases 
analogous to those enumerated frequently come under the observa- 
tion of medical men. A patient now under my care, until the 
age of thirteen, possessed the ordinary range of vision, but too close 
application to study together with confinement, brought on constitu- 
tional derangement, and upon convalescing this defect of vision was 
observed, and has continued for a number of years; at the present 
time occasional indisposition has an evident influence on the adap- 
tive powers of the eye. Mr. Annesley states that hemeralopia or 
night cecity, is especially prevalent among the people of India, and 
he considers it as owing to accumulations of morbid secretions in the 
primae viae, and is always remedied by free purgation. 

From observing the fact that a double concave lens would remedy 
the defect in a near-sighted eye by counteracting, as it was supposed 
the too great convexity of the cornea, it would appear that the chief 
attention of experimenters had been diverted from the other struc- 



Morton on the Jldaptive Powers of the Eye. 55 

tures of the eye, and led them to seek for the explanation of the 
power of adaption, in the alteration of convexity in the cornea alone. 
Now there are some instances where no undue convexity can be ob- 
served, and yet the eye has not the power of adapting itself to dis- 
tant vision. We frequently find artists who are in the habit of 
using one eye only on minute objects, in process of time become 
near-sighted in the eye so used. If we observe attentively the eye 
of a near-sighted person, when directed to distant objects, and fix 
our attention upon the iris, we shall find, when a lens is placed be- 
fore the eye, that the diameter of the pupil is gradually altered, the 
iris shortly becomes stationary, and until this change in the iris has 
been eftected vision is not distinct; evidently proving that a certain 
change must take place in the eye, notwithstanding the aid of the 
artificial lens. 

The influence of the iris in regulating the admission of light did 
not escape the observation of the earlier anatomists; it was observed 
invariably to expand in an intense, and contract in a less vivid light. 
If the eye be directed for a moment towards the sun, the pupil at- 
tains its least diameter. The reverse takes place in the entire ab- 
sence of light — the pupil is enlarged to its greatest extent. Such a 
provision was necessary to guard the delicate organ from the effects 
of intense light, but experiment and observation would lead to the 
conclusion that the iris, besides possessing this instinctive power of 
self-preservation, influences directly the function of vision, that 
while it excludes from the eye too intense a light, at the same time 
it has the power of admitting only such rays as are necessary for 
distinct vision. We might consider the iris as acting under two 
kinds of sensibility, or perhaps mere modifications of the same sym- 
pathy-— that sensibility which protects the retina from too much light, 
and that visual sensibility, (if we may be allowed the term,) which, 
when the iris has adapted itself to the intensity of light in the sur- 
rounding medium, adapts the pupil to the admission of only those 
rays which are requisite for distinct vision. To be assured of this 
we have only to observe the eye while performing its function of vi- 
sion, when it is directed generally to a distant prospect; the iris is 
adapted to that degree of light consistent with its normal function, 
but the instant an object is singled out in the distant prospect, we 
can observe a sensible alteration in the diameter of the pupil, the re- 
sult of a new impulse, and on closer observation the iris will be 
found to vacillate as the object singled out is more or less distinctly 
seen; or perhaps it would be more correct to say, the object becomes 
more or less distinct in accordance with th@ motion of the iris. The 



56 Morton on the Maptive Powers of the Eye. 

motion of the iris when objects are viewed at different distances has 
been observed, but sufficient importance has not been attached to it. 
Under the influence of solar light, this visual sensibility of the iris 
is much less apparent than in its absence; its motion, however, is 
sufficiently evident even to the naked eye, but in a more obscure 
light it is palpably manifest. 

A case is related by Mr. Travers, in his work on the eye, of an 
individual who possessed directly a voluntary power of adapting the 
eye. We are inclined to believe that to a certain extent this power 
is possessed by most individuals; that is, objects at any point of vi- 
sion may be rendered indistinct by what would appear to be a very 
slight exertion of the two internal recti muscles, and if the iris be 
observed at the same time, it will be found to vacillate, contracting 
or enlarging as the object becomes distinct, or the contrary. It is 
true, this motion in the iris, though observable, is not as extensive as 
when the eye is directed, by candle-light, in quick succession from 
distant to near objects, and might leave a doubt whether so slight a 
change in the diameter of the pupil would be adequate to produce 
the effect.* A consideration of the form and action of the iris, together 
with the peculiar properties of the crystalline lens, will perhaps leave 
less reason to doubt the influence the iris possesses of regulating the 
visual rays proceeding from objects at different distances. 

A great deal of minute investigation has been made for the pur- 
pose of deciding the question, whether the iris, properly speakings 
can be considered a muscle. It appears to be a matter of no very 
great importance whether we rank it as a muscle or not, provided we 
can ascertain its structure and function: at any rate, we find it en- 
dowed with some of the properties peculiar to muscular fibre, and it 
is sufficient for our present purpose to consider it as such. It is cer- 
tainly a tissue endowed with peculiar properties; its sympathies or 
sensibility is peculiar to itself. Anatomists describe it as a flat, circular 
muscle, perforated in the centre; this description would be strictly 
accurate only in autopsic examinations, but will not accord with its 
actual form in the living animal, especially during its state of dilata- 
tion, for then it may be considered rather a funnel-shaped muscle, 
resembling the surface of an extremely obtuse truncated cone, its 
top or apex being the pupillary margin, its base the edge inserted or 
arising from the circular margin of the choroid coat. In the living 

* I have, however, frequently been able, while observing" the €3^6 of an in- 
dividual in this condition, to inform him when his vision was distinct or indis- 
tinct, by merely observing- the changes in the diameter of the pupil. 



Morton on the t/^daptive Powers of the Eye. 57 

subject, the pupillary margin is somewhat in advance or anterior to 
its base or origin, and corresponds in direction with the anterior con- 
vexity of the crystalline lens. This peculiar conformation gives to 
the iris a controul over the admission or exclusion of rays of light, 
as it regards the lens, which would not obtain were it either a flat 
muscle, or its points of origin and insertion reversed. This peculiar 
mechanism enables the iris in the most expeditious and effectual man- 
ner to exclude all collateral and unnecessary light, and at the same 
time admit such rays as come in direct lines from the object viewed, 
and confines them to the central portion of the crystalline lens. Had 
its base or insertion been anterior to its pupillary margin, it is evi- 
dent that the diameter of the pupil could not have been adapted to 
receive the direct rays proceeding from objects, without at the same 
time admitting an undue and unnecessary quantity of light within 
the eye; had it been a perfectly flat muscle the same difficulty, 
though to a less extent, would necessarily follow. Its present form 
and action, is, like all the works of nature, a master-piece of me- 
chanism, and calculated in the most perfect and admirable manner 
to produce the desired result. 

The action of the iris, its contraction and dilatation, should per- 
haps be viewed as a motion '' sui generis.,^^ for there appears to be 
no other muscle in the system precisely analogous to it. In consi- 
dering muscular action, we are accustomed to connect the ideas of 
the origin, insertion, and fulcrum of each muscle, and from thence 
infer the intended result or effect produced by their contraction, but 
in the iris we find only its origin, unless we consider its pupillary 
margin as its insertion, but even then we want a fulcrum; in fact, 
its muscular motion is peculiar to itself; the tongue is the only mus- 
cle analogous to it in action, for after protruding the tongue beyond 
the teeth, as far as the motor muscles attached to its root and infe- 
rior surface will permit, we still have the power of elongating and 
of moving in different directions the end or tip to a considerable ex- 
tent. This power is possessed in a much greater degree by many of 
the lower orders of animals — the cow, sheep, dog, &c. ; the cow can 
thrust its tongue a considerable distance within the nostrils; it is, we 
conceive, an analogous species of muscularity by which the leech and 
common earth-worm are enabled to move. 

Such being the admirable mechanism of the iris, we shall have less 
hesitation in admitting that a very slight alteration in the diameter 
of the pupil will be fully adequate, not only to regulate the proper 
quantity of light, but also controul the admission of the necessary 
visual rays. It may appear, however, more satisfactory after taking 

6* 



58 Morton on the Adaptive Powers of the Eye. 

into consideration the peculiar properties of the crystalline lens. It 
v/ill be sufficient for that purpose to consider the lens of the human 
eye as a transparent substance, having its two surfaces composed of 
equal segments of the same sphere, and consequently will possess 
the common properties of the optician's instrument, denominated the 
double convex lens^ its actual form, according to Petit, is that of a 
compressed sphere having its anterior Surface the segment of a 
greater sphere, its posterior the segment of a less. The changes, as 
it regards direction, that rays of light undergo in passing through a 
dense medium of this configuration, can be ascertained by experi- 
ments upon the artificial lens with a sufficient degree of accuracy to 
enable us to draw conclusions relative to the powers of the natural 
lens of the eye. The general properties of a double convex lens are, 
that rays of light which pass through it furthest from its centre or 
axis, are made to converge the soonest, and those rays which strike 
nearest to its centre or axis converge the least. All parallel rays in 
jmssing through the lens have the greatest focal distance, and it is 
this point, the focal distance of parallel rays, by which opticians de- 
signate the power of their different lenses, calculated either by the 
convexity of the sphere, of which they are a segment, or else from 
actual measurement, by receiving the rays of light from the sun, 
which rays may be considered as parallel, owing to its distance. 

According to the known laws of optics, rays of light proceeding 
from objects at different distances, after passing through a double 
convex lens, are brought to different foci, the rays of light from the 
more distant objects being parallel, have necessarily the longest foci; 
the same object, if brought nearer the eye, and seen in its full mag- 
nitude, must be seen by converging rays, the focal distance of which, 
according to the laws of optics, would be less than when the object 
was more remote, and consequently in one or the other instance 
vision, would be defective — if distinct in the remote, it would be in- 
distinct when the object was brought near, or the reverse. Such 
would be the case in an eye wanting an irisf such we find is the 
case in optical instruments, the " camera obscura^^^ &c. | the defect 
in either can be remedied by the same or nearly similar means. The 
iris being capable of contraction or dilatation, accommodates the pu- 
pil to the admission of only a certain number of the more parallel or 
direct rays whose focal distance is uniform, and at the same time ex- 
cludes all indirect or collateral light, which, if admitted, would only 
tend to render the image indistinct. In the camera obscura the same 
effect may be produced by substituting for the iris artificial dia- 
phragmsi in the instrument now before me, though imperfect in its 



Morton on the %^daptive Powers of the Eye. 59 

construction, the screen upon which the images are formed, may be 
moved considerably beyond the focal distance of the lens, so that no 
objects whatever appear upon it, and by interposing an artificial pu- 
pil of a certain diameter, objects become apparent. It would appear 
that the interposition of the iris, while it excludes a portion of the 
indirect rays, confines those that are admitted to the central part of 
the leils, where they consequently undergo less refraction than if they 
were suffered to be acted upon by parts further from its centre or 
axis, and consequently have their focal distance increased. The opi- 
nion entertained by Mr. Travers on the adaptive power of the eye, 
was based upon the supposition of a change of figure in the crystal- 
line lens. He supposed it an elastic body, influenced by the muscu- 
lar action of its surrounding parts, and that both its figure and site 
were changed, whereby its refractive powers were increased or di- 
minished. Now, the influence of the iris renders such a supposition 
unnecessary, because the diameter of the pupil alone will controul 
or alter the refractive power of the lens, as it regards certain rays, 
by admitting the rays of light to be acted upon by different parts of 
the lens possessing at all times different powers of refraction. 

The field of distinct vision is extremely limited, scarcely perhaps 
the twelfth of an inch as it regards the retina; if we observe a person 
while reading, we see the axis of the eyes successively moving from 
point to point, and can observe, even in our own case, that if we at- 
tempt to view distinctly two points, distant from one another the 
eighth of an inch, we feel sensible of an evident exertion in the mus- 
cles of the eye to direct its axis from the one point to the other. In 
viewing a distant prospect the eye possesses a much greater range, but 
is also much less distinct, and individual objects in this prospect can 
only be rendered more distinct by directing the eye to a limited and 
circumscribed point, and the rays of light emanating from tliat point 
must necessarily pass through the more central portions of the crys- 
talline lens. 

The perfect structure of the crystalline lens, together with its 
surrounding mechanism, give to it additional powers^ it is composed 
of concentric lamina differing in density, (and consequently in the 
powers of refraction,) from the centre to the surface; it is contained 
within a transparent capsule, between which and the lens is a pecu- 
liar fluid, denominated the liquor Morgagni. From its anatomical 
structure an optician would infer that it was the most perfect instru- 
ment of its kind, and the immense extent of vision, from a few inches 
to millions of miles, would confirm the opinion. Artificial lenses are 
subject to certain errors, denominated by opticians the caustic curve. 



60 Morton on the Adaptive Powers of the Eye, 

by refraction or spherical aberration; from the established laws of 
matter, the crystalline lens would be subject to the same error to a 
certain extent; this defect is counteracted in a measure by its struc- 
ture, but chiefly by the interposition of the iris; the structure of the 
lens, aided perhaps by the other humours of the eye, the aqueous, 
vitreous, &c. render the organ perfectly achromatic. To avoid these 
various defects, opticians have endeavoured to imitate nature by com- 
bining two plano-convex lenses, and interposing a diaphragm between 
the two plane surfaces; in this, however, they have imitated nature 
imperfectly, for in the one it is fixed and immoveable, while in the 
other it is not only possessed of motion, but a motion in every re- 
spect subservient to the function of distinct vision, as well as the 
preservation of the organ. In adapting the spyglass for the view of 
distant objects, it becomes necessary that the lenses made use of 
should be brought to their respective focal distances, which is effect- 
ed by elongating the tube; at the same time this produces an analogous 
effect to that of introducing a perforated diaphragm, for as the tube 
is elongated, and the lens removed from the object part of the in- 
strument, the virtual diameter of the orifice is diminished, or the 
range of vision lessened, because those rays of light which would have 
struck the lens, if near the object orifice, when it is removed further 
from it do not even reach it, and if placed sufficiently remote, will 
effectually exclude all but the more direct and parallel rays, which 
we think are those chiefly concerned in distinct vision. 

As it regards the defect of vision in near-sighted eyes, as well as 
that change which is found to take place in old age, it would appear 
that too much importance has been attached to the influence of the 
cornea, and accounted for by the action of the recti muscles, and in 
old age by the absorption or diminution of the different humours. I have 
frequently examined the corneas of near-sighted persons, where not the 
slightest degree of undue convexity could be detected; and on the other 
hand, I have seen many who had unusually convex corneas, and yet 
did not labour under the defect usually attributed to this peculiar 
conformation. I have recently had this observation confirmed in the in- 
stance of an individual under my care, whose cornea was so extremely 
convex, that when the eyelids were closed, it formed a protrusion ele- 
vating the lid several lines above the sclerotic surface, and evident 
at a considerable distance when the eye was closed and made to roll 
in its socket; the adaptive powers of the eye were nevertheless un- 
usually perfect. There are, no doubt, many instances where this de- 
fect of vision is accompanied with a great convexity of cornea, but it 
does not necessarily follow that it should be the cause of it. 



Morton on the Adaptive Powers of the Eye. 61 

This great convexity of cornea, which in the human species is con- 
sidered a defect, is found to exist in many animals that seek their 
prey by night. All the animals of the species '^Felis" are remarka- 
ble for their aciiteness of vision; "the eye of the lynx" has become 
proverbial; like the domestic cat, their corneas being the segment of 
a smaller sphere, may perhaps be considered much more convex than 
that of the human eye, but the perfection of their organ would seem 
to result from the expansive and contractile power of the iris. The 
immense play of the iris in the domestic cat, and the acute sensibili- 
ty of the retina to light, is truly astonishing; now the owl does not 
possess an equal play of the iris, and we find in the broad glare of 
daylight they see but dimly if they see at all. There is no doubt but 
the pliancy or mobility of the iris may be increased by practice; we 
find that artizans constantly engaged in minute work, provided they 
do not use an artificial lens have the microscopic powers of the eye 
greatly increased; but the constant and long-continued action of the 
iris deprives it of the power of requisite contraction for distant vi- 
sion; and again, sailors who are much accustomed to discern distant 
objects, and use their eyes a great deal by night, have their respec- 
tive powers much more developed and perfect. 

The pathology of the organ of vision affords a great number of facts 
which would seem to strengthen the opinion as it regards the influ- 
ence of the iris in the proper adaptation of the eye. In the fifth vol. of 
the Medico-Chirurgical Review a case is related of total, though tem- 
porary Jjlindness, attended with excessive enlargement of the pupil, 
and we know that sudden fear produces a similar effect upon the 
iris, and attended with the same defect of vision. In most cases of 
*Mritis," indistinctness, followed by total loss of vision, commences 
with the irregular contractions of its muscular fibre; and after the 
operation for artificial pupil, when the iris has lost its powers of con- 
traction and dilatation, the eye also loses its adaptive power, and re- 
quires the aid of artificial lenses. If the irregular contractions of the 
iris render vision indistinct, it would be important in the operation 
for artificial pupil, to take into consideration not only the requisite 
or most convenient diameter of the pupil, but also its form and situ- 
ation; for Mr. Guthrie in his work on artificial pupil, remarks, that 
the more the rays of light are directed to the central portion of the 
lens, the powers of vision are much more augmented than when the 
artificial pupil is made so large that rays are admitted upon its cir- 
cular margin. Indeed opticians are generally agreed that only the 
central portion of their lenses are of use, and by the adoption of dia- 
phragms, they render useless, as it regards the transmission of lightj 



63 Morton on the Adaptive Powers of the Eye. 

any other portion. The central portion may be all that is necessary 
in optical instruments, as they are generally used to view single ob- 
jects, or at any rate their field of vision is extremely limited, and 
only make use of the more parallel and direct rays. But the me- 
chanism of the human eye gives it additional powers. Our bountiful 
Creator, in giving to the eye of man its powers of adaptation, enables 
him to survey at one glance immense portions of the universe, and 
under the controul of his will, by the same power can examine in de- 
tail each single object^ in like manner the camera obscura possesses 
a great range of vision, but it possesses not the power like the eye to 
single out individual objects and render them more distinct. Neither 
the anatomy nor the physiology of the organ of sight will support the hy- 
pothesis which presumes the adaptive power to be the effect of the 
action of the recti muscles; in fact, this muscular apparatus connect- 
ed with the eye, is designed for a motion of a different nature than 
that of changing the spherical form of the ball itself; it is for the pre- 
servation of the organ itself, and for the purpose of directing, under 
the controul of the will, the axis of the organ to the object viewed. 
To support the hypothesis of tlie four recti muscles, we must pre- 
sume that they act in unison, that they all contract or relax at the 
same moment; this presumption, has however, never been proved by 
observation or experiment; but supposing they did, it would only 
produce the required change in the figure of the eye, when its axis 
was directed in a horizontal direction, directly forward; for the in- 
stant the axes of the eyes assume an oblique direction, one of the 
four muscles must be in a state of relaxation. But if we closely ex- 
amine the motions of the eye, we will be satisfied that all the mus- 
cles do Hot contract simultaneously, but follow the general law of 
muscular action throughout the system; that is, when one muscle 
contracts its antagonist relaxes. It is true we have the power of 
contracting the two internal recti at the same time, and direct the 
pupil inwards towards the nose; but we have no similar power over the 
two external recti, and thereby to direct the axes of both eyes outwards 
at the same time; and it may be explained upon the difference of nerv- 
ous distribution — nerves of voluntary motion being distributed to one 
pair of muscles, and nerves of involuntary to the other; this subject, 
however, has become one of so much interest, since the elucidation 
of the nervous system by Mr. Bell, that it should not be even refer- 
red to in so cursory a manner. If the influence of the iris is as im- 
portant as it really appears to be, it will explain those changes which 
are observed to take place in more advanced life. As we descend in 



Morton on the Adaptive Powers of the Eye. 63 

the vale of years, all the muscles, articulations, tissues, &c. become 
more rigid and less pliant than in youth, and there seems no reason 
why the muscular fibre of the iris should be an exception to this ge- 
neral law of nature. When the iris by age loses its activity and pli- 
ability, and no longer acts in unison with the visual sensibility of the 
retina, the eye is in that condition which frequently follows certain 
constitutional derangements, iritis, or when the operation for artificial 
pupil has been undergone. 

Our limited knowledge of the operation of mind upon matter will 
not enable us to decide whether the motions of the iris are or are not 
wholly independent of the will, and the difficulty is still further in- 
creased by the complicated nervous distribution to the organs there 
is no organ in the system to which so many different nerves are 
sent, and all designed for distinct functions. It receives nerves of 
voluntary motion from the third pair, or motores occulorum, a nerve 
of involuntary motion from the fourth or trochleas, branches from 
the fifth or ophthalmic of Willis, which is a nerve of ordinary sensa- 
tion, and this last branch is joined by a nerve from the great sympa- 
thetic. In addition to these, the extreme branches of the optic nerve 
are freely distributed on its internal surface. To explain the sym- 
pathies consequent to this extensive nervous distribution, if it could 
be done, would afford matter for a distinct treatise. 

If the views we have taken of the properties of the lens and the 
influence of the iris be correct, the mechanism by which the eye 
adapts itself may be better understood. The iris, by its contraction 
or dilatation, admits the requisite number of visual rays to pass 
through that portion of the crystalline lens which will cause them to 
reach the retina ut their proper foci, while at the same time it ex- 
cludes in the most effectual manner all unnecessary light, and all 
collateral or indirect rays. With this view of the subject, many of 
the anomalies of vision can be much more satisfactorily explained. 
The singular defect of vision which occurs occasionally to Mr. Aber- 
NETHY, the talented professor of St. Bartholemew's Hospital, is of 
that description which we are rather inclined to believe should be 
attributed directly to the irregular contractions of the iris, though 
induced, it is highly probable, by a certain morbid condition of the 
retina. On certain occasions he can only see one-half of any object 
viewed; on observing himself in a mirror, but half of his face is dis- 
tinctly visible; looking at his name upon the door-plate only a part of 
the letters are distinctly seen. A similar effect can be produced in 
the instrument now before me, (constructed as nearly as possible to 



64 Morton on the Adaptive Powers of the Eye. 

resemble the human eje,) by bringing the opening in the artificial 
iris either above or below the central portion of the lens, whereby 
certain of the direct rays coming from the object are intercepted, 
and consequently only a part of the image will be distinctly painted 
upon the screen. The cases which Mr. Abernethy alludes to, and 
considers analogous to his own, are purely the result of a morbid 
condition of the nervous system, and cannot be explained upon the 
known laws of optics. The instances he quotes are those where in- 
dividuals see, or rather think they see, objects that are invisible to 
persons around them. Such cases are by no means uncommon, and 
in the complaint denominated "delirium tremens" are almost a con- 
stant symptom. The case related by Mr. A. was that of a gentle- 
man, who, while reading in his study, on turning his head, observ- 
ed, as he thought, a woman in a red cloak seated in a chair near him. 
So complete was the illusion, that he addressed her and inquired 
how she came therej receiving no answer, he ordered her out of his 
presence, and expostulated with her for not obeying him. At length 
he rose from his seat, rang for his servant and ordered him to turn 
her out. The servant assured him that there was no woman or red 
cloak in his presence; he then sent for his physician, very naturally 
concluding that his nervous system was deranged. 

Now it cannot be presumed that in this instance there were rays 
of light reflected from a woman in a red cloak and impinging upon 
the retina of his eye; but it is equally certain that at some former 
period all this had taken place, and that the gentleman had actually 
seen just such an accoutred woman, whose image upon the retina had 
produced a certain impression upon the sense of vision, and at the time 
the mind may have taken cognizance of it. At any rate, the image 
once upon the retina left a certain impression, which the organs con- 
stituting the sense of vision had the power to exercise and with the 
same degree of vividness as it had once appeared; not by a volun- 
tary effort of the mind, because it appeared whether he would or 
not. He might say with Macbeth, " Avaunt and quit my sight, un- 
real mockery hence!" but there it remained 'Mike the air-drawn 
dagger, in form as palpable as that which once he saw." In fact, 
we are hourly convinced that the mind has as lim>ited a power of re- 
calling sensations as it has in exciting or controlling the functions 
of the involuntary nerves. It would seem that, that portion of the 
brain which gives origin to the nerves of sense^ performs its function 
to a certain extent^ independent of the cerebrum, or that portion of 
the encephalic apparatus which is at present considered the organ or 



J 



Morton on the Adaptive Powers of the Eye. 65 

medium for the exercise of intellect or volition; and the mind, how- 
ever it may recal its own emotions, the result of sensation, has but a 
limited power over the sensation itself. 

Let the mind endeavour to picture to itself the person or portrait 
of an intimate and absent friend, and after the greatest exertion how 
faint and indistinct the picture will be vrhen compared to that por- 
trait which we must believe the senses conjure up during the partial 
repose of the intellect. When dreams disturb the curtained sleep, 
how vivid are all the sensations, and yet in what unnatural and ab- 
surd combinations do they come before the dozing mind. 
" Strange dreams, that give a dead man leave to think." 

Are not these rather the offspring of the senses than involuntary 
aberrations of the mind? Are not the sensations of the maniac, and 
the perceptions arising from them, as real and substantial as though 
they originated from present sensations? and yet we know that the 
real material object, the sound, the smell, and the touch, that once 
imprinted them on the organs of sense, is not at the moment present.* 

Such hallucinations, however, as those recorded by Mr. Aber- 
nethy, and others of daily occurrence, should be considered as func- 
tional derangements of the whole nervous system, and are to be ac- 
counted for or explainedby the physiologist and metaphysician, while 
the defect in his own case is directly owing to an arrangement in the 
mechanism of the eye, and admits of explanation upon the known 
laws of optics. For in his own case there were rays of light reflect- 
ed from a material body and impinging upon the retina of his eye, 
and we are inclined to believe that upon close examination it would 
be found that the irregular contractions of the iris brought the pupil 
in that position as it regards the lens, that the rays of light did not 
strike equally upon its central portion. The consequence would be 
that half or a portion of the rays would be intercepted, some of those 
admitted would be unduly refracted, the remainder would be brought 
to their proper foci, and that portion of the image would be distinct, 
the other indistinct or perhaps invisible, according to the extent of 
the derangement in the action of the iris. 

New Fork, «dugust, 1831. 

* Be this as it may, our present knowledge of mind as connected with mat- 
ter, is by far too limited to lead to any certain conclusions. 

No. XVII.— Nov. 1831. 7 



66 North's Cases of Cutaneous Diseases, 



Art. V. Cases of Cutaneous Diseases^ with Pathological and PmC' 
tical Remarks, Bj Dr. Milo L. North, of Hartford, Conn. 

Case I. — in the summer of 1818, a child about five years old was 
affected with a scaly eruption, accompanied with a discharge of lim- 
pid and puriform fluid, with heat and soreness, and occupying the 
neck and upper part of the thorax and shoulders. There were some 
appearances of disordered first passages. 

A mixture of one part of pulverized rhubarb and two of carbo- 
nate of magnesia, rubbed in treacle, taken morning and evening, suf- 
ficient to procure two or three evacuations daily, in the course of 
three weeks caused the eruption to disappear, and the skin to be- 
come smooth. No external application was used except unguentum 
sambuci. 

Case II. — Two children of the Rev. C. C. of Vermont, both un- 
der five years, were submitted to my treatment in the same season, 
1818, for a papular eruption covering nearly the whole surface of the 
oldest, and entirely that of the youngest. The heat and itching were 
extremely troublesome, particularly during the night. Several plans 
of ineffectual treatment had previously been prosecuted under the 
direction of the physicians in his vicinity. Ten drops of the follow- 
ing liquid were administered three times daily, in an ounce of sweet- 
ened water, for several weeks: — -R. Acid, muriatici, 5j*? Alcohol, 
5j. ; Misce. The following ointment was applied to the skin morning 
and evening: — R. Adipis suillse, j^j.j Acid, nitrici, ^j; Misce. 
Their complaints, after a primary aggravation of several days, which 
I had not then learnt was commoii in the convalescence of cutaneous 
diseases, began to yield, and within a few weeks entirely disappear- 
ed. The father afterwards wrote me that he had prescribed the same 
course to the children of several of his neighbours with the same 
happy result. 

Case HI. — Mr. S. B. aged sixty, of good general health, accus- 
tomed to all the indulgencies pertaining to the pantry and cellar of 
a wealthy New England farmer, was affected, in the autumn of 1819, 
with heat, itching, and redness upon the leg, succeeded by scales, 
and a secretion of acrid, limpid fluid. These symptoms were most 
troublesome at night while the patient was in bed. From December 
15th to January 15th, 1820, as he was of full habit, and had a strong 
pulse, he was bled twice, took various cathartics and antimonials. 



North's Cases of Cutaneous Diseases. 67 

and had the solutions of acetate of lead and muriate of ammonia ap- 
plied to the affected limb. From the whole course of these remedies, 
occupying a month, I could not perceive the least benefit. I had 
urged him repeatedly to curtail his generous diet, but he conformed 
very poorly to my request. It became, therefore, necessary for me 
either to discontinue my visits to him, or to persuade him to comply 
strictly with the proposed course of regimen. Although I was not 
then so fully convinced as at present, that in the fluctuations of ex- 
ternal and internal disease, that of the skin might so utterly absorb 
the whole morbid action as to leave the digestive organs free from 
apparent disorder, yet I gave him all the assurance I dared, that if 
he would enter upon the prescribed course of diet, he might hope 
very soon to be freed from his trouble. 

In reply, he laid it down as a principle, warranted by plain com- 
mon sense, that while his taste was natural, his tongue clean, his 
stomach free from oppression, flatulence, acidity, and all uneasiness, 
his appetite strong, and his bowels in a natural state, he was unable 
to perceive any use in the proposed course of self-denial. To gratify 
my wishes, however, he would consent for a season to its adoption. 
He then restricted himself to such a course of aliment substantially 
as is accordant with our most approved authors of the present day on 
that subject, including an entire omission of cider and fermented li- 
quors, and, without any modification of the medicinal course, he was 
quite well within two weeks. 

Remarks,— T\iQ above case disclosed to me experimentally two 
facts worthy of observation and remembrance, viz. the comparative 
importance of the hygienic and therapeutic measures employed, and 
the mode in which morbid action of the cutis may so absorb the in- 
ternal disorder of the digestive organs as to allow them to carry on 
their functions without any manifest disturbance. In the younger 
members of our profession, it needs both firmness of nerve, and de- 
cision of opinion, to persevere in a course of diet and medicine when 
the patient thinks it unnecessary, and in violation of plain common 
sense. 

Case lY.-— January 22d, 1823. Capt. H. B. aged eighty-six years, 
had for thirty years been troubled with ulcers upon the legs, accom- 
panied with a cutaneous eruption gradually increasing to this time. 
For ten or fifteen years past he had been unable to labour, since 
which, his disorder had increased more rapidly. Both legs were now 
enormously swelled, hard, livid, hot, itching intolerably, covered 



68 North's Cases of Cutaneous Diseases. 

with scales from the toes to above the knees, exposing a red, leather;f 
surface wherever thev fell off, and aggravated bj an acrid, watery se- 
cretion. He was of very full habit, face red, neck fleshy, pulse hard, 
and tongue somewhat furred. His legs were so hot and painful that 
he had but little rest till the latter part of the night, when the febrile 
disturbances kept up in the gastro-intestinal organs subsiding, he was 
able to sleep till nine or ten in the morning. He had taken brandy 
sling, temperately, three times a day for twenty years at least, and 
had doubtless taken spirits more or less ever since the revolutionary 
war, in which he was an officer. He had always eaten meat two or 
three times a day with such accompaniments as we are accustomed 
to see on the tables of our substantial farmers. For some time past 
he had had a diarrhrea, for which an opium pill had been taken every 
evening. He had followed no course of internal remedies that had 
proved effectual. Acetate of lead with laudanum, muriate of ammo- 
nia, and various kinds of poultices, had been among the topical ap- 
plications employed. 

After a long time spent in arguments and explanations on my part, 
and much hesitation on the part of the patient, whether to comply 
with the terms which I proposed, in limine, as a sine qua non, or to 
send me home without prescribing, I succeeded in engaging him en- 
tirely to suspend the brandy, cider, and opium, and to confine him- 
self exclusively to rice, crackers, milk-toast, gruel, bread and milk, 
and other articles of a similar kind. Gingerbread, plain puddings, 
and codfish, were occasionally allowed. He took, every second day, 
an active cathartic of sulphate of magnesia in infusion of senna, and 
on the intervening days, pulv. rhei and magnesia combined as a laxa- 
tion. His drink was a saturated solution of super-tartrate of potass, 
with as much of the tartrate of antimony in the same as the stomach 
would bear without disturbance. Flour was the only application 
made to the limbs. 

Although I had taken the precaution to acquaint him that the first 
effect of the course would apparently aggravate his sufferings, yet I 
was not prepared to expect the reproachful look and language I re- 
ceived from my veteran patient as I entered his apartment four days 
afterwards. As he had never passed the bounds of respectable so- 
briety, he thought it cruel and unreasonable that the faculty could 
not cure his sore legs ! without depriving him of the good things which 
Providence had put into his hands. He persevered, however, and 
within two weeks from my first visit, there was an amelioration of 
all his symptoms. The diarrhoea disappeared, the sw^elling, heat, 



North's Cases of Cutaneous Diseases. 69 

itching, and redness of the limbs diminished, his breathing became 
less stertorous, and his sleep improved. The watery humour had 
changed into a thick, purulent secretion. After this change was ef- 
fected in the morbid secretion, the following was applied morning 
and evening in conjunction with the above-prescribed course of me- 
dicines and regimen: — R. Acidi nitrici, ^j.5 Adipis suillag, Jfej*? 
Misce. The nurse told me she frequently removed a saucerful of 
scales at a dressing. 

February 17th. — The legs soft, and healing rapidly. All the 
symptoms improved. Continued same treatment. 

March 22J. — Took my leave of the patient. Legs soft. Eruption 
gone. Sleeps well. Is able to labour. Adheres to the prescribed re- 
gimen. 

February 25ih, 1824. — Capt. B.'s legs are entirely free from any 
eruption or ulcer. His health and activity constantly increasing. 
Adheres to the temperance plan. 

August 15th, 1831. — The above patient, now ninety-four years of 
age, is still living, and I presume very well, as I have heard of no 
illness that has occurred to him. 

Remarks. — This extensive eruption and swelling of the limbs pro- 
bably prolonged the patient's life, by diverting diseased action from 
the digestive apparatus and brain, and fixing it upon the skin and 
cellular tissue. While labouring in the field, the abundance of per- 
spiration, and the salutary employment of the muscular energy, pre- 
served such a balance between the income and expenditure of the 
system, as to preserve a tolerable share of health. But on becoming 
more infirm, and gradually relinquishing labour, while the reciprocal 
eifects of alcoholic stimuli and high-seasoned food caused him to take 
an equal amount of nutriment, the balance of healthy action was de- 
stroyed, and a constant gastro-intestinal disturbance produced. 

At what point, theii, did diseased action commence in this case? 
I answer — in the digestive apparatus. The long-continued practice 
of stimulation and excessive repletion, had established a morbid ap- 
petite, requiring such an amount of ingesta to satisfy its cravings as 
to transcend the digestive powers, and thus, to the diseased appe- 
tite, was added constant irritation of those passages. Here the dis- 
ease commenced — a purely factitious disease — produced by the "re- 
freshments" of the distiller, and the boasted blessings of a generous 
table and a good cook. Had this individual shared with the Hindoos 
in their daily allowance of boiled rice, his case never would have 
reached the ears of the faculty. 

7* 



70 North's Cases of Cutaneous Diseases* 

He had originally, and has now, an iron constitution. As proof of 
this, it is interesting to trace the various efforts it manifested to with- 
stand the noxious effects of his regimen. An ulcer upon each leg 
first availed as an outlet — a wastegate for the disease of the first pas- 
sages. These becoming inadequate, the skin in the neighbourhood 
cooperated in sharing the latent disturbance within. This combined 
affection of the skin and cellular tissue, served for many years as a 
vicarious disease. In the mean time the system had become so ple- 
thoric, and the adipose substance so abundant, that he was thought 
by his friends to be on the borders of an apoplexy. 

Hence, although there were no positive proofs that the brain was 
diseased, yet we need have no hesitation in saying, that the danger 
of a sudden failure in that organ was greatly diminished by the cuta- 
neous affection, and, therefore, that this last affection held a patho- 
logical relation to the brain, as well as to the gastro-intestinal organs. 
The large intestines were at length enlisted in behalf of the indivi- 
dual, by a copious, watery secretion, in form of a diarrhoea. This, 
had it not been thwarted by the opium pills, would doubtless have 
diminished the plethora, and alleviated the febrile disturbances con- 
stantly propagated from the gastric organs. As it was, the diseased 
process was rapidly increasing in the lower extremities, manifested 
by the swelling extending above the knees, and by an aggravation of 
all the symptoms above-described. 

From the history of the above case, and the result of its treatment, 
are we not warranted in the conclusion, that the disease com- 
menced in the gastric organs; that it existed there in a latent state; 
that, in consequence, the brain became predisposed to disease; that 
the chronic affection of the lower extremities was sympathetic of the 
original disorder, vicarious in its nature, and tending to diminish the 
danger of the more central organs? The writer is fully aware that 
these sug2;estions do not put on the air of novelty to those who are 
acquainted with the pathological doctrines of this enlightened period. 
But as truth is the only object of his inquiry, and as the above case 
and its results are substantially similar to many that have occurred 
to him, and which might be adduced, he deems it matter of gratu- 
lation, rather than of apology, that a line of practice which has been, 
almost without exception, successful, should be found conformable 
to pathological opinions already established. 

I have hitherto confined my remarks mostly to the connexion be- 
tween diseases of the skin and those of the stomach and associate or- 
gans. That there is an intimate connexion between the secerning 



North's Cases of Cutaneous Diseases. 71 

fiinctions of the skin and the lungs, kidneys and bladder, there can 
be no doubt. But my own observation has not furnished any striking 
instances of association in the diseases of the skin and these organs. 

In the various instances of recession and reappearance of erup- 
tions which have fallen under my notice, I do not recollect an in- 
stance in which the kidneys, spleen, or bladder, have appeared to be 
the seat of the disease which had been thrown vicariously upon the 
dermoid system. 

Disease, in its various metastases, occasionally passes from the 
brain, heart, or uterus, to the cutis, and vice versa. The liability to 
such alternations should be kept in mind, both in reasoning upon cu- 
taneous affections, and in their treatment. Yet the pathological con- 
nexion of these organs with the skin is manifested so rarely in actual 
practice, as to render it unnecessary to trespass further on the pa- 
tience of the reader in its consideration. 

That non-contagious cutaneous diseases, in this climate^ generally 
originate from, and are connected with, a previous morbid state of the 
stomach, small intestines, liver, and pancreas, may be further esta- 
blished by the following considerations, 

1st. From analogy. Gout, erratic rheumatism, itching at the nose 
from worms, ophthalmia, amaurosis, sore throat, hysteric paroxysms, 
convulsions, and numerous other irritative diseases, are generally ad- 
mitted to arise from sympathetic connexion with these organs. 

Qd. From the consideration that the mucous membrane in the im- 
mediate neighbourhood of these organs, and lining them, is the in- 
tervening barrier between the general system and all noxious sub- 
stances swallowed, and is destined to receive their first effects. In 
animals provided with instinct, directing them what to choose and 
reject, this membrane may pass for years without disease. But in 
omnivorous man, this delicate organ is brought in daily contact with 
articles injurious to its texture and functions^ such as tea and coffee 
at a temperature wholly insupportable to the skin, distilled liquors 
that cannot be held in the mouth five minutes without sensible pain, 
acrid and corrosive condiments, rich gravies, pastry, sweetmeats, 
and in short all the mischievous inventions that the art of modern 
cookery has congregated from the animal, vegetable, and mineral 
kingdoms. Nor is the quality of these agents all. They are ren- 
dered so delicious to the palate, that, in this land of abundance, they 
are taken in at least double the necessary quantity^ and the physi- 
cian who undertakes to combat American diseases, and overlooks 
these multiplied causes of gastro-intestinal disturbance, has jet to 
learn one of his elementary lessons. I have seen a copious crop of 



73 North's Cases of Cutaneous Diseases. 

fiery, itching pimples follow within a few hours a free indulgence in 
pickles, hard peaches, almonds, nuts, fresh pork, or minced pie. I 
have seen these disturbances as speedily subside by taking one or 
two compound rhubarb pills, or other bitter stomachic. As all per- 
sons are not predisposed to diseases of the skin, other sympathetic 
effects may be manifested from these noxious impressions^ but those 
who labour under this predisposition, and are willing to observe the 
effects of particular articles of diet, can perceive an immediate ag- 
gravation of their eruption after indulging in the forbidden diet. 
These effects are often so speedy as to demonstrate that the gastro- 
intestinal membrane must be the part that suffers: for it must seem 
impossible that the first operation of an emetic, which removes the 
internal agent and external disturbance together, can eliminate any 
foreign principles that may have found their way into the blood. 

M, The proposition is supported by post mortem examinations. 
The number and variety of lesions in the gastro-intestinal mucous 
membrane that have been recently reported in our medical journals, 
show unequivocally that these lesions have heretofore been overlook- 
ed. These instances of ulceration, erosion, thickening, and inflam- 
mation, are precisely what we should expect from the structure and 
functions of this membrane. Dr. Gregory remarks that "the pain 
which accompanies inflammation of the mucous membrane is slight 
in comparison to that of inflammation of the serous membrane. The 
intestinal tract is remarkably prone to run into ulcerative action, 
and the rapidity of this action is worthy of note." Practice, L 9JQ, 
'« Pustulous inflammation in the follicles of the mucous membrane 
is a disease which readily assumes a chronic character and often ter-- 
minates in ulceration of the aftected cryptae." Bayle and Hollard^s 
General Anatomy. "Without attempting to judge of their reciprocal 
influence, it is evident that cutaneous diseases often coincide with 
inflammation of the internal organs." BieWs Lectures, "At times 
diseases of the lungs or alimentary canal are met with, (in dissect- 
ijig fatal cases of erysipelas,) whose existence had never been sus- 
pected." Ihid. " Ulcers are very rare on the inner membrane of 
the trachea and urethra, but very common on the inner membrane of 
the large and small intestines." Bailiie^s Morbid Anatomy. 

4th. The Similarity of structure between the skin and gastro-in- 
testinal membrane, strongly marks the connexion between the dis- 
eases of those surfaces. Indeed, these organs are considered in struc- 
ture nearly identical by anatomists, from Bichat downward, differ- 
ing only in the absence of the inner cuticle; and even this is sup- 
plied by a different substance lining those parts of the intestinal tract 



North's Cases of Cutaneous Diseases. 73 

^here the epidermis cannot be distinctly separated. The alterations 
of disease from the external to the internal tegumentary membrane, 
and vice versa, are like the wanderings of erysipelas, erythema, or 
herpes from one part of the skin to another. The blotches of the 
rum-drinker's face are the mere effects of continuous inflammation, 
and are the index of the scorched and reddened state of the inner 
surface, which has endured the burning stimulus of gallons and bar- 
rels of diluted alcohol. But these considerations are too obvious to 
detain the reader longer on this head. 

5th. Another proof that the gastric organs are the primary seat of 
disease in cutaneous affections, is drawn from the fact, that in most 
instances these organs manifest immediate signs of disease- in cases 
of sudden recession of eruption from the skin. This is mdre espe- 
cially noticeable in the minor eruptions, such as erythema, roseola, 
lepra, psoriasis, &c. Every physician knows that patients are uni- 
formly worse in their general health when their disorders have "struck 
in." Salt rheum and erysipelas, the former of which in common 
language answers both to lepra and psoriasis of Biett, and the latter 
to erythema, meet us at e\ ery corner. In all cases where the pa- 
tient's disorder is not of a grave character, there has been a uniform 
connexion between the gastric organs and skin in these alternations, 
as evidenced by nausea, faintness, fluttering, pain in the side, stric- 
ture about the epigastrium, &.c. It is a common occurrence to ob- 
serve sore ears and other eruptions in children cured by a sponta- 
neous diarrhoea. There is no doubt, however, that the brain and 
lungs do occasionally receive the burden of a receding eruption. 

And here I beg to be distinctly understood, that in establishing the 
connexion between the non-contagious eruptions and the gastric or- 
gans, and the fact that these organs are diseased antecedently to the 
skin, I do not pretend to explore the ultimate origin of disease. The 
diseases of both these localities may be^ and probably are, the effects 
of an ulterior but obscure cause, influencing thevwhole habit of body. 
We say of a fatal erysipelas it has ''struck to4he brain." But who 
does not know that the inflammation of the external teguments in 
erysipelas is nothing in comparison with that which is produced by 
burns, scalds, &c. and which is attended by no danger? How plain 
it is that the cutaneous inflammation in the^ febrile form is the mere 
index to the deadly disorder within,. JThe popular pathological opi- 
nions of the day would refer the ultimate cause of failure to the brain 
and nervous system. This may be the true explanation: but we are 
to keep in mind that the kmns already alluded to, which late dis- 



74 North's Cases of Cutaneous Diseases. 

sections have detected, are more unequivocal in the lungs and first 
passages than in the brain. 

In cases of the recession of long-continued cutaneous disease be- 
ing followed b J death, "it is not improbable that some fatal mis- 
chief arising from some ulterior cause had so weakened the powers of 
life, that nature was unable to free herself longer from that encum- 
brance she used to throw off* upon the skin." — Heberden. 

6tlu The last consideration I shall adduce is derived from the 
means employed ill the cure of cutaneous diseases. Cathartics, tinc- 
ture of cantharides, and the arsenical solution skilfully managed, and 
accompanied with a strict attention to diet will lead to very satis- 
factory success in the treatment of these complaints. It has been my 
own plan to commence at once with cathartics, much in the manner 
recommended by Dr. Hamilton. Calomel, calomel and jalap, senna 
and sulphate of magnesia, have been favourite articles, and given 
every second day to produce free catharsis. In the intervening days 
a laxative of powdered rhubarb and magnesia. This course should 
be continued, if necessary, at least four weeks. 

As to diet, no absolute rules can be given, but I have seldom 
known such a patient bear fresh pork, sausages, rich gravies, pastry, 
nuts, pickles, raw vegetables, stuffings, acrid condiments, or any 
farinaceous substances recently cooked. Cider and all fermented li- 
quors and fresh pork I have found particularly injurious. I have no- 
ticed that melted butter and fat are more indigestible than the same 
articles in a solid state; and this is accounted for on the principle, 
that when masticated with bread and other articles, they render 
these substances impervious to the saliva. Even in a solid state they 
are to be used very sparingly if at all. 

Local applications are always thought necessary by the patient, 
and are of use, though in a very subordinate degree compared with 
internal remedies. I have found nothing equal to nitric acid and 
lard, in the proportion of one ounce to the pound. If the diseased 
surface is quite hot and inflamed, the ointment should be weakened 
by the addition of an equal quantity of lard, and even this should be 
delayed till the surface indicates some improvement from the internal 
remedies. I formerly used to raise the lard to a high heat, and gra- 
dually add the acid, which was thus decomposed, and an oxygenated 
ointment formed. This has appeared to me more efficacious than the 
same composition formed without heat. This should be applied every 
evening, and followed in the morning by a tepid alkaline wash, con- 
sisting of 5ij. of the sub-carbonate of potash or soda, to one pound of 



North's Cases of Cutaneous Diseases* 75 

water. When the eruption is general, an occasional warm bath in 
the evening, containing from four to eight ounces of one of the above 
articles, would be desirable. 

Should the skin not become decidedly improved in four weeks, the 
cathartics should be suspended. The daily administration of an ape- 
rient, of rhubarb and magnesia, with a blue pill, every evening, will 
often effect a cure if continued several weeks, and if the patient can 
be brought to a rigid obedience of the rules of regimen. 

If these measures fail, let five drops of the tincture of cantharides 
be given every morning for six days, when it will be proper to in- 
crease the dose, one drop daily, till heat at the epigastrium, or symp- 
toms of strangury, show that it has arrived at the maximum dose. 
The medicine can then be continued in a somewhat less quantity for 
four or six weeks from commencing its use. By this very moderate 
medication, the patient is acquiring more restraint over his morbid 
appetite by his lengthened discipline: an acquisition of great mo- 
ment to an individual possessed of a predisposition to cutaneous af- 
fections. 

Should the cantharides fail, continuing all other means, it would 
be necessary to commence the use of Fowler's arsenical solution, in 
the dose of three drops every morning, eating a light breakfast, and 
gradually increasing it to twenty drops. In the dose of twenty drops 
twice a-day, I have known it produce surprising effects in the rapid 
disappearance of an extensive cutaneous and subcutaneous affection 
of the back. The mucous membrane of the stomach was, however, 
so much irritated by these powerful doses, that a severe ophthalmia 
was sure to be produced if the medicine was continued over ten days 
at once. 

If, by thorough explanations and arguments, the patient can be 
brought to a compliance with the prescribed diet, and made to feel 
that thence forward he is to use great caution in the indulgence of 
appetite, the most difficult point is gained. This difficulty is the 
grand reason why we meet with so many incurable cases. It will 
be seldom in our climate, that, with this point gained, one of the 
above courses, and generally that of cathartics, will fail to restore 
the patient to health. 

The inquiry arises, and it shall be despatched very shortly, how 
does the mode of treatment illustrate the connection between the dis- 
eases of the gastric organs and the skin.^ No language can form a 
more appropriate answer than the following, applied by Dr. Good 
to a singular and very obstinate case of lichen: " The patient was at 
length fortunate enough to be put upon a brisk course of calomel, of 



76 North's Cases of Cutaneous Diseases, 

which he took five grains every night, with a purge of rhubarb or 
cathartic extract next morning, for nearly a fortnight in succession^ 
and, having thus transferred the morbid irritability of the skin to 
the intestinal canal, the disorder left him." — Study of Medicine, 
V. 379. 

This, say the disciples of Broussais, is substituting one disease 
for another, and is producing internal perturbation. The charge 
is admitted. We apply our remedial agents to the internal tegu- 
mentary membrane, while they, by a much more operose method, 
apply theirs to the external surface by means of leeches, douches, 
medicated baths, blisters, cataplasms, &c. The practice of Brous- 
sais is equally a perturbating course, but applied to a different part 
of the tegumentary system, with this important difference, that, re- 
lating to the diseases in question, it is far less successful. In the ad- 
ministration of calomel, jalap, senna, sulphate of magnesia, cantha- 
rides and arsenic, the impressions are primarily and chiefly produced 
upon the stomach, small intestines, and auxiliary viscera. Tincture 
of cantharides, applied to the skin, produces vesication. In suffi- 
cient doses it must produce an analogous effect on the internal sur- 
face. The well known action of arsenic on the skin points out its 
effect internally. If a solution of tartrate of antimony h^ frequently 
given to a patient in peripneumony, to the extent his stomach can 
bear, and if it be prevented from passing below the stomach and 
duodenum by calomel and opium, there is produced a crop of pus- 
tules on the membrane in question, as is demonstrated by the pus- 
tules which appear in the mouth and fauces. And this has long ap- 
peared to me a satisfactory explanation of the success of the Italian 
method of treating pneumonic inflammation; that, by blisters exter- 
nally, and a factitious disease in the oesophagus, stomach, and duo- 
denum from antimony, the organ originally diseased is surrounded by 
artificial inflammation, and by the cooperation of the calomel and 
opium, speedily extricated from danger. If the antimony is allowed 
to pass into the large intestines, the internal counter-irritation in the 
immediate neighbourhood of the lungs is prevented, and the principal 
benefit of the practice is thwarted. 

The fact is, the stomach and small intestines are the seat of injuries 
from without; there disease is first enkindled. By the salutary ten- 
dencies of nature, these organs are allowed to perform their func- 
tions without transmitting to the sensorium any notice of disease 
there, while the vicarious, morbid action is thrown upon other parts 
of the system, and, in patients predisposed, upon the skin. To re- 
move this vicarious action of which the individual complains, we ex- 



Williams on the Use of Conium Maculatum, 77 

cite impressions in the very seat of the disease, which are styled per- 
turbations, but which being artificial, serve to transplant the original 
morbid action, and substitute a new one. This, after being conti- 
nued from two to twelve weeks, wears out or eradicates the original 
disease, and then both the vicarious disorder without and the arti- 
ficial one within necessarily cease. 

Hartford^ Conn, Jiugust 9.9th, 1831. 



Art. VI. On the Use of Conium Maculatum in Affections of the Fe- 
male Breast^ and in Cancerous Ulcerations. By Stephen W. 
Williams, M. D. late Professor of Medical Jurisprudence in the 
Berkshire Medical Institution. 

1 BEG leave to select for the Journal the following cases from my 
medical and surgical note book, in which I have long been in the habit 
of recording what I conceive to be important facts and cases. 

Cancerous ulcerations. — Under this head I propose also to treat of 
the sequelae of mammary abscesses, which, if neglected, frequently 
terminate in cancer. I am inclined to believe that a remedy will yet 
be found for the cure of cancerous affections, and I think the faculty 
have underrated the powers of conium maculatum in these cases. 
This medicine was in high repute with the ancient physicians; pro- 
bably by them it v/as too much extolled, and like many valuable 
medicines which were employed by them, it has, from this circum- 
stance, gone into disrepute. Medicine, like other things, has its 
fashions. Within half a century, bleeding and powerful depletions 
have been in and out of fashion at least half a dozen times. Bleeding 
is now in vogue to a great extent, particularly in chronic affections 
of the lungs and liver. A reaction will probably soon take place, 
for, like all violent complaints, a crisis soon obtains. I believe 
in no catholicon m any complaint: what may be useful in one may 
not be in another, or even in the same in different individuals, 
owing to peculiarities of constitution. Yet I think that facts in fa- 
vour of conium maculatum are multiplying. The following have oc- 
curred in my practice. I am not able to state them so minutely as 
I could wish, as many years have elapsed since some of them oc- 
curred, and I took no notes of them at the tim„e. 

Case I.— A woman from Hawley called upon me in the summer 
of 1820, with an indurated breast. Several months previously she had 
No. XVII.— Nov. 1831. 8 



78 Williams on the Use of Conium Maculatum. 

had a milk abscess, but I do not recollect whether it had ever been 
opened. At any rate the whole breast became completely indurated, 
and did not yield to any remedies lier physician prescribed. At the 
time I saw her, the breast was large, the whole substance of it was 
indurated, unequal, and knotty, and all the integuments of it black. 
There were very slight constitutional symptoms. I directed the use 
of the white pond-lilly poultice, (Naphe advena,) for a few days, 
hoping by the use of it to induce suppuration. After this, if any 
hardness remained, I prescribed the powdered leaves of conium, com- 
monly called cicuta, and directed them to be sprinkled upon the 
poultice, and if they could not be obtained, I advised the use of a 
plaster of the extract of conium, and to continue the use of it as long 
as any hardness remained. I directed at the same time the internal 
use of the extract, beginning with small doses and gradually increas- 
ing until constitutional symptoms appeared. I am not able to give 
a detail of the progress of the cure, but I learnt that she followed 
my directions, and in tlie course of a few weeks was completely 
cured. 

Case II. — Mrs. K. of Greenfield, soon after delivery, was se- 
verely afflicted with milk abscess, which suppurated, and was open- 
ed several times. It was many weeks before the abscess healed. 
After it did heal, the whole of the breast became indurated, and as 
hard as stone. Various discutients were applied, such as mercurial 
ointment, camphorated liniment and spirit, &c &c. to no effect. 
I applied a plaster to her breast of the extract of conium, which she 
continued for several weeks, and recovered completely. 

Case III. — Mrs. G. of Sunderland, had borne several children. 
Soon after the first one was born, she had a severe milk abscess. She 
was not able to suckle her child any more from that breast. With 
each succeeding child she had abscesses in the breast, which became 
more and more severe. The in4urations which succeeded remained 
from one pregnancy to another. At last obstinate sinuses followed, 
which were laid open in all directions; these were followed with very 
troublesome funguses, which discharged a great quantity of fetid sa- 
nious matter, and yielded to no remedies which had heretofore been 
administered. A celebrated surgeon who attended upon her repeat- 
edly, told her that there was no other possible chance of saving her 
life, than by removing the breast by the knife. She was pale and 
emaciated, and evidently rapidly declining. She was unwilling to 
submit to the operation, and sent for me. I found her as above de- 



Williams on the Use of Conium Maculatum. 79 

scribed. I was inclined to believe that the surgeon was correct, and 
that the breast must be removed, but she was so anxious to try some- 
thing else, that I consented to gratify her. I put her upon the use of 
the conium pill, and directed the use of the pond-lilly poultice, 
sprinkled with the powdered leaves of the conium. In a few days I 
saw her again. The matter discharged was much more bland, and 
less in quantity. It continued to decrease, and by the time that con- 
stitutional symptoms from the use of the pills manifested themselves, 
the sinuses were dried up. I then directed a plaster of the extract 
to her breast, which was worn till the indurations were completely 
removed. She recovered. She has since had children, but her breast 
has never troubled her any more. 

Case IV. — It is but justice to remark, that in a subsequent case I 
have used the conium without success. The case was, however, 
somewhat different. Mrs. S. of Conway, applied to me for advice 
in the winter of 1826. She was between forty and fifty years of 
age, and had ceased bearing children. She first noticed an indura- 
tion in her breast a few months before. When I first saw it the 
whole breast was diseased, and of a stony hardness. It was much 
enlarged and puckered near the nipple. The skin was excoriated, 
and an ichorous matter was discharging from it. She had sharp, 
lancinating pains, and every indication of real cancer, attended with 
constitutional symptoms. It was my opinion that a resort to the 
knife was now too late. I directed the external and internal use of 
the conium, in which she persevered a long while without avail. A 
cancerous ulcer succeeded, which destroyed her in about nine months, 
which was the most rapid of any thing of the kind I had heretofore 
seen. This, and some other cases of cancer, forcibly reminded me of 
the lines of old Turner, and likewise of the almost absolute necessity 
of immediate extirpation of all malignant scirrhosities of the breast 

" Is there a man you hate, 
Or wish the hardest fate, 
Bid neither plag-ue nor pox. 
Nor fam'd Pandora's box, 
Bid neither gout nor stone, 
But, letting- these alone. 
If wretcheder you'll make him. 
Then bid the cancer take him." 

Case V. — The following case promises a better result. Mrs. F. 
of Buckland, called upon my father and myself to consult us upon 
an affection of her breast, in the summer of 1827. She was between 



80 Williams on the Use of Conium Maculatum. 

forty and fifty years of age, and her youngest child was about four 
years old. She had been troubled with milk abscesses with her former 
children. When young, her breast had been injured, probably from 
pressure from the use of stays, a prolific source of cancer of the 
breast. The nipple was flattened, and she was never able to ruckle 
from that breast. At the time we saw her the nipple was drawn in, 
and the breast around it was much puckered. It had been in that 
situation several months. The whole circumference of the areola was 
enlarged and tender. There had been an abscess under the lower 
part of the areola which had discharged, and still continued to dis- 
charge a small quantity of thin matter. The opening would scarcely 
admit the head of a small probe. It occasionally scabbed over. In 
the upper part of the breast there was a scirrhous tumour, of a stony 
hardness, about the size of a butternut. It hurt her to press upon it. 
She was of the nervous temperament, and had been taking medicine 
for some time. When we saw her, her physician pronounced, with 
a great deal of confidence, that it was a case of real cancer, and said 
nothing but the knife would effect a cure. We prescribed for her 
the external and internal use of the extract of conium, and a conti- 
nuance of the blue pill, which she was then taking. I saw her a 
fortnight after 5 the swelling around the areola had subsided^ the 
scirrhus had also diminished, and the soreness had left her. The 
matter discharged was of better consistence. Directed to continue 
the remedies. Saw her again in another fortnight^ she was under the 
full influence of - the conium. She said it made her drunk. Her 
breast appeared^4n every respect, better, and there was every pros- 
pect that she would soon recover, and I afterwards learnt that she 
did recover. 

Case VI. — The following case shows that the conium has been 
successful in a case of real open cancer. In July, 1827, I took a 
short excursion upon our western mountains. On my journey I was 
requested by Dr. Deane, of Colrain, to visit a patient of his, Mrs. 
S. who was troubled with an affection of the breast. She had been 
confined to her room several weeks. On opening the door I most 
* sensibly perceived that most disagreeable smell which is so peculiarly 
and characteristically attendant upon open cancer. I examined her 
breast. There was an open, deep, ragged ulcer upon it, nearly the 
size of the palm of my hand, it was discharging a thin, ichorous, 
and highly offensive matter, in large quantities, and occasionally 
blood. It had somewhat the smell of old brass or copper when ex- 
posed to heat and moisture. The edges were jagged and callous, and 



Wright's Baltimore ^Ims-house Reports, 81 

the whole breast was of a scirrhous hardness. It had been open se- 
veral months, and there had been an induration in her breast several 
years. Her constitution was much aflfected, and she was confined 
to her room, and the principal part of the time to her bed. The pain 
in her breast was intolerably severe. The stench was so great in her 
room that her attendants could not bear to stay with her. At the 
time I saw her she was taking large doses of laudanum to alleviate 
her distress. As I had no expectation of curing her, I advised Dr. 
Deane, merely for palliatives, to wash the breast freely with salt 
and water, to make use of a carrot poultice, sprinkled with powder- 
ed conium, and after the stench was removed, to use the conium 
plaster, and at the same time to put her upon the internal use of ex- 
tract of conium, until constitutional symptoms were induced. On 
the 12th of October, I saw Dr. Deane, who informed me to my great 
surprise, that Mrs. S. had completely recovered, and that her breast 
was entirely healed, and as smooth as his hand. The next summer 
I was called to visit a patient in Colrain, and called on Mrs. S. and 
found her perfectly well. 

I have since used the conium externally and internally with com- 
plete success in the case of Mr. H. N. of Greenfield, who, for a 
number of months, had been aftected with scrofulous indurations 
about the glands of Ws neck. 

Deerfield, Mass, Sept. 1831. 



Art. VII. Reports of Cases treated at the Baltimore Mms-house In- 
firmary, By Thomas H Wright, Physician to the Institution. 

Case I. — Vaginal tubercle. — The following case presents a speci- 
men, uncommon for its magnitude, of that form of morbid growth 
generally located at the outlets of the cavities, upon or near the 
meeting line of the mucous membrane and the common skin. 
A young woman, J. Grifiin, about twenty years of age, represented 
to belong to the unhappy class of female profligates, was brought to 
the Baltimore Alms-house. The persons who delivered her to the 
charge of the institution gave no account of the cause, manner, or 
other circumstances of her illness. Its nature was inferred from her 
course of life, and on that presumption she had been placed in the 
syphilitic ward for females. On the day after admission the case came 
under examination, presenting the following signs. Form much wast- 
ed, face sallow arid wan, deep hectic flush on both cheeks, eyes in- 

8* 



82 Wright's Baltimore Alms-house Reports* 

jected, expression wild and frightened, lips dark red and parched, 
fauces inflamed, gums spongy and foul, tongue swoln, strong flesh- 
colour, surface dry, polished. Breathing was hurried, skin hot, pulse 
small, and past counting with precision. The intellect was disorder- 
ed, perceptions confused, mind agitative, with a cast of delirious 
wandering in all the mental operations. 

In addition to the symptoms noted, there was an odour from the 
person of the patient which revealed the existence of some local 
aff*ection in the sphaceloid state. To inquiry respecting the condi- 
tion of the external sexual organs, it was communicated by the nurse 
of the ward, that there existed something about the female parts of 
uncommon appearance, and in a very foul state. On inspection, a 
pyriform tumour of great size was observed| its larger extremity be- 
low, and suddenly contracted above into a neck or peduncle, con- 
necting it with the left side of the vagina, which was dragged out or 
prolonged unnaturally by the weight of the pendant mass. The tu- 
mour was regular in form, of firm texture, occupied all the upper 
space between the thighs, and from its size and solidity was sup- 
posed to be from five to six pounds in weight. The general aspect 
of the mass gave the representation of a two-fold manner of develop- 
ment. A regular fibriform tumour seemed to have been first pro- 
duced, and afterwards a dense crop of small tubercles of the ver- 
nicous kind, appeared to have sprouted from the surface of the pri- 
mary body, and now completely and uniformly overspread it. These 
surface vegetations were about the size of a filbert, diminishing in 
bulk toward the root or neck of the tumour. They were round, 
coarsely granular on the exterior, and bore no small resemblance to 
our common blackberry in the unripe state. The lower extremity of 
this great mass, for about one-fourth of its whole length, was in the 
sphaceloid condition^ smell putrescent, colour black red, cuticle 
desquamated, free sanious exudation, circular line of demarcation to 
sphacelus, dead structure somewhat shrivelled and collapsed. 

By the copious issue of sanies with some haemorrhage from the 
sphaceloid extremity of the tumour, the whole mass was blood-stain- 
ed, so as to disguise its real character and cause it to appear as be- 
longing to the tumours of fungoid constitution, for one species of 
which, (the cauliflower,) it was at first mistaken. Examination sub- 
sequent to the cleansing of the parts showed the whole appearance as 
above described, anil corrected the erroneous opinion first formed. 
It was now evident that the tumour was a magnified specimen of that 
form of excrescence, which, under the denomination verrucas, or 
waity tumoursj infest the vestibulum of the female parts of genera- 



Wright's Baltimore Alms-house Reports. 83 

tion. The present example of that kind of production was not only 
uncommon for its magnitude, but possessed characters of solidized or- 
ganization, belonging rather to the fleshy tubercle than to the verruca 
proper. Its locality, its covering of coarse skin, and above all, its 
surface studded with hundreds of minor warty excrescences, pointed 
out its relation to that class of tumours, and in connexion with its 
size and solidity seemed to indicate in the present specimen a com- 
bination of the tubercle and the wart. The mass appeared abun- 
dantly vascular, as exhibited both by a tendency to somewhat free 
hsemorrhage, and the detection by pressure on the neck of the tumour 
of bold pulsation at several points. 

The case was at first in no condition for immediate resort to ope- 
ration. The serious exhaustion of the patient on admission rendered 
attention mainly and urgently necessary to the constitutional state. 
To tranquillize and sustain were the indications of the moment, to 
which removal of the local evil was a remote and secondary consi- 
deration; the morbid aspect of the tumour was the consequence, not 
the occasion, of intense constitutional disorder, developed from other 
and unknown causes. The tumour was directed to be enveloped in 
cloths charged with the spirit lotion, applied warm; the general means, 
small cordial anodynes, (spt. lav., ammonias, and tinct opii,) in 
effervescing draughts, frequently exhibited until they produced their 
calming influence. These were aided by sponging with cool spirits 
the abdomen. Diet light and moderately cordial; rice-jelly, with 
small addition of wine. 

In a few days the aspect of the case was sensibly bettered. Sleep 
had been procured; the tum.ult of mind and body was allayed; incli- 
nation for nourishment a little restored; strength somewhat revived. 
Advantage was taken of this state, to remove the now completely 
dead and offensive portion of the tumour. It was separated by a pair 
of large strong scissors — but the division was not easily effected, re- 
quiring much force and numerous cuts. The substance was tough 
and harsh, dividing like leather, or raw hide, in the macerated 
state. 

On the decline of fever, and of the signs of gastro-intestinal irrita- 
tion, the patient was put on the use of bark infusion with the mine- 
ral acid, and diet reinforced. Her improvement, seconded by a con- 
stitution naturally good, was constant and rapid. The remains of 
the tumour, still equal nearly in bulk to a small child's head, as- 
sumed the hue and actions of healthy structure; the point from which 
the dead portion was removed, partly by section, and in part by 
spontaneous separation, contracted, and was closing in by active 



84 Wright's Baltimore JUms-house Reports. 

cicatrization. The tumour now presented the following character 
and connexions: — The mass external to the vestibulum, as before 
described, was a large oval bod j, solid, inelastic, and heavy, covered 
by an extra growth of innumerable small tumours, or tubercles, of 
the filbert size; colour of the tumour white, resembling common in- 
tegument, only very coarse, or papular. The neck of the tumour 
was about two inches long, three broad, (from above downwards,) 
and one inch thick; its inner face, next the ostium vaginae, was 
smooth, like the mucous membrane of that canal on the stretch; the 
external side like common skin. The labium majus of the left side, 
with its common covering, was on the outer side of the neck of the 
tumour; the nympha was distinguishable on the inner surface of the 
same part; the latter body very small, a transverse ridge merely, - 
scarcely elevated above the plain of the surface. The root of the tu- 
mour thus appeared to protrude from between the labium and nympha 
of the left side, coming out betwixt the ramus pubis on one side, and 
the vaginal expansion on the other. The flattened, but thick root of 
the tumour, could be traced some extent up the left side of the va- 
gina, covered by the wall of that canal, but its exact place of origin 
or termination above the ramus pubis could not be distinguished. 

The whole mass was removed by operation, in one of the modes 
commonly employed for excision of such tumours. To prevent much 
loss of blood, as well as with the purpose of dividing the neck of the 
tumour as high as possible, a strong needle, armed with a coarse 
double ligature, was pushed through the centre of the root close upon 
the ramus pubis. The ligatures were tied above and below, pressing 
them well toward the base at the time of drawing the loop. The sec- 
tion was mad6 with a scalpel, cutting across the neck just without 
the ligatures. Notwithstanding the means employed to obviate hae- 
morrhage, the dash of blood from the face of the cut was profuse; the 
ligatures did not effectually compress the portions included, and it 
was necessary to command the bleeding by firm pressure with the 
fingers against the ramus pubis within, until the vessels could be 
taken up. This part of the operation was tedious and difficult, in 
consequence of the alarm and struggles of the patient, and great re- 
traction of the root of the tumour within the vestibulum. By the te- 
naculum and the needle, where the latter suited best, the haemor- 
rhage was controlled without immoderate loss of blood. There was 
but little inflammation or swelling after the operation. The young 
woman regained her health rapidly, and in six weeks was perfectly 
well; reported by the nurse of the ward to be without any thing un- 
natural about the parts from which the tumour had been removed. 



Wright's Baltimore Alms-house Reports. 85 

Case IL— 'Glandular Tissue, Indurescence, Suppuration, and Ex- 
crescence of the Testicle, mistaken for Carcinoma. — A young man, 
twenty-five years of age, wagoner by occupation, entered the Balti- 
more Ahns-house with disease of the testicle, ensuing, by his report, 
to severe and neglected gonorrhoea. State of parts on admission: 
left testis enlarged to thrice its natural size, hard in places, inelastic, 
not tender to moderate pressure; surface of the gland rough and 
fibrous, as if traversed by numerous chords or thin bands; scrotum 
dark brown colour, contracted close around testis, at many points 
indented by union with the membranes and gland. From the whole 
front of the testis protruded a mass of the size of a pullet's egg, of 
coarse, granular substance, secreting profusely a mixture of sanies 
and pus. The base of the excrescence was broad and hard, its body 
elevated, flattened on the top — whole bulk exceeding the size of the 
testicle; scrotum around the base of the vegetation thick, adherent, 
and callous feeling. By pressure on the parts, a soft pulpy matter 
could be made to ooze out at some points where union of the scrotum 
to the base of the excrescence was incomplete. The funis of the left 
testicle was thick as a finger, knotted and hard; superficial lympha- 
tics of both groins enlarged; cellular tissue, same seat condensed; in- 
guinal glands swelled and tender to touch. Right testis retracted 
high, very little altered from natural state, except by adhesion of 
scrotum, vaginalis, &c. at a few points. Duration of the local dis- 
ease now, by account of the patient, eleven weeks; parts had never 
been very painful; occasional sense of stinging and burning in the 
part — the chief unpleasant feeling. 

The man represented the affection of his testicle to have com- 
menced, (while he had gonorrhoea,) by general enlargement of the 
gland, followed by a dark red swelling on the front part, which slow- 
ly gathered, burst, discharged a reddish matter for some time, then 
large granulations shot out from the cavity of the abscess, and conti- 
nued to grow and overspread the gland, as they appeared at the time 
of his admission into the house. The parts had been constantly irritat- 
ed by riding on horseback in his employment as teamster. The per- 
sonal appearance and condition of the subject of this affection was 
strongly marked by signs of constitutional disorder. Form, naturally 
stout, was considerably emaciated; skin flaccid and sallow; face con- 
tracted, look desponding; tongue furred; appetite indifferent; bowels 
laxative; distressed by flatulence; pulse small and quick; surface dry; 
sleep irregular and uncomfortable. By all the signs, local and con- 
stitutional, the disease of the testicle seemed to be represented as 
one of the malignant class of tumours, fungus hematodes, or medul« 



86 ' Wright's Baltimore Mms-house Reports. 

lare. Operation in prospect was adverted to, as soon as by rest, re- 
gulated diet, and suitable alterative medicines, due preparation of 
the system was accomplished. The patient was put on the use of 
Plummer's pill reduced in strength, first with opium added for loose 
bowels, and free use of the diet drink; regimen, boiled milk, rice, 
and bread. The part was treated by simple fomentation and 
poultice. 

The general circumstances of this case were so much mended after 
some time in hospital, (end of second week,) that the patient both 
looked and felt very sensibly better than when admitted; his com- 
plexion, spirits, appetite, and strength, were greatly improved. The 
local disease was not materially altered, otherwise than by greater 
cleanness, a better secretion, more puriform, from the ulcerous sur- 
face; better colour of the fungous growth, and less soreness of the 
parts, particularly of the inguinal indurations. These changes, slight 
as they were, taken in connexion with the obvious melioration in the 
general functions, under mere rest and simple treatment, seemed so 
strongly to contradict the presumption of malignancy in the disease 
of the part, that as soon as they were displayed in an unequivocal 
manner, I did not hesitate to recal the opinion first expressed, and 
to deprecate the contemplated resort to operation, as unwarranted 
by the present aspect and circumstances of the case. The local dis- 
ease was now exhibited as essentially the result of irritable inflamma- 
tion, aggravated constantly by manner of life, exposure, and neglect. 
It was noticed as probable, also, that the strumous diathesis was pre- 
sent, and concurred to complicate the affection, both by additional ir- 
ritability in the habit, and the peculiar tendency it is known to impart, 
to conversions of textures not belonging to the common forms of in- 
flammation. Hence the chronic induration of the tissues, partial, (tu- 
berculoid,) suppurative degenerescence, and subsequent vegetative 
development in the part; hence too the manner and form of sympa- 
thetic irritation and change' in the neighbouring lymphatic and cel- 
lular structures. 

On this pathology of the affection it was conceived highly probable, 
that perseverance in the same general regimen, with the steady em- 
ployment of caustic to the part, would accomplish enough to exclude 
occasion of resort to direct surgery. By maintaining a good state of 
the general system, and constantly repressing the products of mor- 
bid action in the part, the irritability on which that action was sus- 
tained would be extinguished, and a healthy process be set up for re- 
pair of the organization. Time realized this expectation. The fun- 
gus was touched over daily with the solid nitras argenti, and after- 



Wright's Baltimore Jllms-house Reports, 87 

wards wrapped in poultice. The application gave little pain, and 
did not excite inflammation. After a few days' use of the caustic, 
the bulk of the morbid growth was sensibly lessened; continued em- 
ployment of it brought the tumour down to near the level of the skin, 
while the discharge from its surface became good, and the margin of 
scrotum around the base of excrescence softened, contracted, and 
was cicatrizing. — In a month the mass of vegetation from the testis 
was demolished, and the general health of the patient reestablished. 
As the excrescence wasted, the enlargement of the body of the testi- 
cle was found to reduce in a gradual manner, and to resume some- 
thing of its natural form; its irregular hardness and fibrous feel also 
diminished. The treatment by caustic was continued as long as any 
tendency to excrescence was apparent; the poultice was laid aside 
when the marks of inflammation were dissipated, substituted by 
dressings with ungt. oxyd. hyd. rub. The part finally cicatrized, 
leaving the body of gland enlarged in some degree, but without evi- 
dent signs of disease. The secondary affection of the lymphatics, 
ganglions, and cellular tissue of the groins, subsided so as to be in- 
considerable at the time the man left the hospital. 

Case III. — Fibro-serous Tissue — Osseous Conversion. — A man, 
sixty -five years old, school-teacher by profession, was admitted 
into the Baltimore Alms-house, on account of a scrotal tumour, 
which had become so inconvenient as to prevent continuance m his 
usual occupation. The patient betrayed marks of age beyond his 
time of life. Form thin, skin loose and shrivelled, hair perfectly 
blanched; in other respects reported himself to be pretty well, had 
not been sickly, was not conscious of any other disease than the scro- 
tal enlargement for which he had come into the house. Tiie com- 
mencement of the tumour was dated by himself five years back; ori- 
gin spontaneous, or without any known cause. 

On examination, the scrotum was developed to a size seldom at- 
tained in mature hydrocele, but the tumour differed in shape from 
common enlargement by vaginal dropsy. The development was al- 
most wholly on the left of the raphe scroti; tumour of that side obtuse 
conoidal, the apex below; greater diameter near the exit of the chord 
from the ring. The covering of the tumour, the scrotum, instead of 
being thick, and somewhat rugous, as is common in hydrocele, was 
thin, smooth, and glistening. Its thinness was quite remarkable, be- 
ing scarce equal in density to the skin on the back of the hand. This 
attenuated integument played freely over an enclosed body; the lat- 
ter so firm as to yield scarcely at all to pressure, and tha* only in 



88 Wright's Baltimore Alms-house Reports* 

places, there being parts or patches of the tumour so hard as to give 
no sense of sinking under compression; nothing of the elasticity which 
was distinguishable at other points or places. After much examina- 
tion by the touch, the reflection of light, &c. the tumour was made 
out to be a hydrocele of unusual form, and with the peculiarity of the 
vaginal coat studded by patches of earthy conversion. The plates of 
calcareous matter in the vaginal cyst were numerous, hard, and 
smooth on the surface next the scrotum. On the right side of the 
scrotum existed another tumour of much less size than the one just 
described. This second tumour reached only half the length of that 
on the left side, was about the bulk, and had very much the form of 
a large hen's egg, was perfectly regular and smooth on the surface, 
with the investing scrotum adapted closely to it, and this integument 
very much attenuated, as in the case of the other, or left tumour. 
The body contained in the right side of the scrotum was heavy for its 
bulk, and every where hard and unyielding to pressure. While the 
large tumour of the left vaginal sac was irregularly hard, and sensi- 
bly compressible in places, (the elasticity of strong membrane tightly 
distended,) the smaller body of the right side was equally and posi- 
tively resisting at all points, and wholly unalterable in form by any 
force which it was deemed allowable to use. The figure of this tu- 
mour, the equal surface over which the scrotum glided smoothly, and 
the feeling imparted to the hand while examining it, all forcibly sug- 
gested the resemblance of an egg enclosed in a covering of skin. 
The lower end of the body was something largest, smaller extremity 
presenting to the ring. The chord could be distinctly traced entering 
abruptly, or attached to, the upper end of the tumour, was thin, soft, 
and perfectly natural, to the point where it entered, or appeared to 
enter, the small end of the body embraced by the scrotum. 

All the marks exhibited by the tumour of the right scrotum made 
it plain beyond doubt, that the tunica vaginalis testes of this side had 
undergone complete and universal calcareous conversion. The kind 
of resistance to the touch was wholly different from that quality of 
firmness, (often very great,) possessed by hydrocele when the sac is 
tense and the membrane thickened. In the case before us it was po- 
sitive hardness, a form unchangeable in the smallest degree at any 
point, and a surface uniform and equal, insomuch that the scrotum, 
(as before noticed,) moved over it as if having no connexion what- 
ever with it, other than as a containing envelope. Neither of the tu- 
mours were in the least degree painful or tender to pressure, and had 
never caused inconvenience of any sort but by their size and weight. 
The space of chord which was free and pliant at the upper end of the 



Wright's Baltimore Alms-house Reports. 89 

tumours, was sufficient for safe and convenient excision, and after 
due consideration, the operation, (by castration,) was judged advise- 
able, and recommended. But when the patient understood that the 
relief offered him was no less than actual emasculation, his timidity, 
or his pride, took the alarm, and, under a privilege of going out for 
some purpose, he left the house, and did not return. 

Case IV. — Muscular Tissue — Calcareous Deposite. — Among the 
conversions to which the muscular tissue is liable, suppuration, indu- 
rescence, pulpy or lardaceous degeneration, &c. it has been doubted 
by pathologists of high authority, whether the muscular texture pro- 
per, was ever the seat of calcareous conversion, or submitted to that 
change commonly discriminated by the term ossification. The fol- 
lowing case may be added to the scanty record on the affirmative side 
of this question, and appears to furnish, substantially, the kind of 
proof which the controversy calls for. Yet this case does not fill the 
vacancy of evidence on that part of the question which demands an 
instance of ossiticalion in the muscular fibre, wholly primitive in the 
seat where it is founds originating in, and restricted to the muscular 
texture, and not produced or piopagated to that organism, by exten- 
sion or encroachment of the ossitic process set up in other tissues, to 
w4iich such a change is easy or common. 

A man, about thirty years of age, was brought to the Baltimore 
Alms-house, January, 1831, in a stale of low exhaustion, ensuing to 
the joint influence of long inleaiperance, and much exposure to the 
rigour of the season. The endeavours to sustain him proved iaeffiac- 
tual, and he died on the third day from his admission. In the exa- 
mination of this patient when first brought into hospital, it was no- 
ticed that one of his legs was very much deiormed by morbid enlarge- 
ment, of irregular figure and singular iiardoess. There was extensive 
cicatrization on the leg, as if from former soresj but at this time the 
surface was no where ulcerated. After death the deformed leg be- 
came the subject of examination, and tL'e liard enlargement, inequa- 
lity, &c. of the limb, was then found to be caused by exostosis of the 
fibula in its whole extent. Two parallel spines, or ridges of super- 
ossification, were produced, from the edges of the fibula down its en- 
tire length 5 they were more than an inch deep, and spread outwards 
from their line of origin, so as to give the fibula the appearance of a 
long bony trough, wider at top than bottom. Between the anterior 
spine or ridge, and the tibia, and raised considerably above them 
both, appeared a bundle or tract of matter, distinct from both bones 
of the leg, but nearly as solid and bone-like as either in the greater 

No. XVII.— -Nov. 1831. 9 



90 Wright's Baltimore Mms-house Reports. 

part of its extent. In places this interposed substance was made up 
of hard and soft matter intermingled, and at those points retained a 
good deal the colour, texture, &c. of muscular fibre, blended with 
much earthy matter. In other places, some inches in length, the struc- 
ture of the part resembled an entire rough, bony body. Where the 
substance under consideration was least solidized, it was very much 
increased in bulk, forming at two or three points in the length of the 
leg, large knobs in a semi-converted state, thus showing the cause of 
the general increase of volume, as well as irregularity of form, no- 
ticed in the limb on first inspection of the case. This intermediate 
osseo-muscular structure was composed of all the muscles on the an- 
terior aspect of the leg between the bones — the tibialis anticus, ex- 
tensor proprius, pol. ped. extens., long, digit, ped. sc. all degene- 
rated more or less completely into osseous matter, and fused into a 
complex mass. 

Although it appears probable that super-ossification in the present 
instance was first set up by the periosteum of the fibula, and was 
propagated to the inter-osseous muscular tissue, yet the conversion 
of the muscles does not appear to have been accomplished by di- 
rect extension, or mere augmentation of earthy matter from the 
primary source of deposit. The semi-ossified mass of muscles was 
distinct and separable in its whole course from the bones of the 
leg, and by osseous development of the fibula inwards, had been 
pressed up so as to lie above them both. The stimulus or irrita- 
tion to morbid secretion may have been imparted by similar action 
in the neighbouring tissues, but the earthy deposit amongst the 
muscular fibre seems to have been properly the work of its own ves- 
sels of nutrition. 

Case V. — Vascular Tissue — Dilatation^ Varix,, ^c. — A middle- 
aged woman, long resident in the Baltimore Alms-house, and subject 
to epileptic attacks, presented the following abnormal developments 
in part of the vascular system. On the right half of the frontal bone 
appeared four distinct tumours, or prominences, of a soft, compressi- 
ble character, and made up apparently of numerous cysts or cells 
communicating with each other, and thus composing one large pouch 
or sac — irregularly defined in its base, and lobulated on the surface. 
One great sac, larger than the rest, was placed near the outer angle 
of the eye; another occupied the midspace of the superciliary ridge, 
overhanging and continued upon the upper eyelid, a third stood on 
the top of the os frontis near the angle of junction with the right pa- 
rietal, and a fourth was directly over the line of union of the internal 



Wright^s Baltimore Alms-house Reports. 91 

angular processes of the frontis, where they receive the ossa nasi, 
overlaying the latter bones, and deriving its covering in part from 
the skin of the nose. All those tumours, or pouches more properly, 
pulsated strongly in correspondence with the stroke at the wrist, and 
could all be flattened or emptied by pressure with the fingers.* The 
coverings of those pouches, the common skin of the parts, was thin 
and delicate, apparently much attenuated and weakened by disten- 
tion. Besides the greater sacs already described, numerous small 
risings, size of large peas or beans, were dispersed over the temporal 
portion of the right frontal and parietal bone, and a few of the same 
kind before and behind the ear. These smaller tumours also kept 
time with the general pulse of circulation. 

The state of the arteries on the opposite sides of the neck and head, 
in this case, was very palpably different. Those of the left side, the 
common carotid and temporal, &c. felt nearly as they are found un- 
der ordinary circumstances; there was, however, some departure, 
both in the size and action of those vessels, from a strictly natural 
or common state. Their volume was more developed to the touch, 
their action sharper, with a very perceptible thrill or jar in the stroke, 
of the kind denominated aneurismatic. It was in the arteries of the 
right side of thenpck and hpad, however, that all those characters of 
faulty state and action were strongly displayed. The common ca- 
rotid was here very sensibly enlarged; its undue size and overaction 
palpably evident, not only to the touch, but to sight; its action un- 
controlled by pressure, and the current through it attended by a thrill 
so bold and distinct as to impart an unpleasant grating sensation to the 
fingers. This peculiarity of movement became greater as the vessel 
was traced toward its root, and was particularly strong in the inno- 
minatum. The dilatation of the common trunk of the artery was par- 
ticipated by all the branches of the external carotid. The occipital, 
in its tract along the base of the skull, was plainly visible in form 
and action, and felt scarcely less in size than the little finger. This 
vessel, as well as the front and middle branches of the temporal, gave 
distinctly the thrill so remarkable in the common carotid. The ge- 
neral circulation in this case was every where more vivid, marked by 
a higher tone of action in the heart and arteries, than is common in 
the female habit. 

* The cysts could be depressed by the point of the fingers until something* 
like incavatiou of the bone was perceived; represented by a hard, rough mar- 
gin, corresponding to the outline or base edge of the tumours. 



92 Wright's Baltimore Mms-house Reports. 

The patient's report respecting the duration of the tumours about 
the head, dated them back about three years; for which period also 
she had been subject to epileptic paroxysms. The latter had been 
renewed from that time at monthly intervals, more or less regular. 
Whether the tits of epilepsy anticipated, in point of time, the swell- 
ings on the head, was not clearly discriminated in her own recollec- 
tion; she thought they had occurred much about the same time, but 
inclined to the opinion that she had suffered one or two attacks of 
epilepsy before the swellings on the head were observed. She repre- 
sented herself to have been much subject to head-ache prior to oc- 
currence of fits, or the local affection, and still suffered greatly from 
frequent and violent pain of the head. She complained likewise of 
almost constant annoyance, particularly of late, by a sense of full- 
ness, with a peculiar irritation, in the membranes of the nostrils and 
palate. 

The regular and strong pulsation of the whole group of tumours on 
the side and front head, their locality in the tract and at the termi- 
nations of the temporal artery, with the palpable enlargement and pe- 
culiar thrill in the carotid of the same side, all seemed to mark the 
case as one of arterial dilatation complicated with varix. The case 
was examined by many physicians and surgeons, who concurred in 
regarding it as a varicose affection of the arteries of the part, with 
probably something of the aneurism by anastomosis in the seat of the 
large pouches. The nature and tendency of the local developments, 
with their probable agency, if not in producing, in aggravating the 
epileptic concomitant, suggested a practical resort, which was deemed 
the proper corrective of the former, and likely at the same time to 
avert or mitigate the latter. Tying the common carotid was recom- 
mended as essential to the cure of the local disease, and affording a 
chance of arresting the epileptic paioxysms. Such a measure was 
also indicated by other considerations besides the prospect of relief, 
or the possibility of cure, it was supposed to offer. The tumours 
were manifestly on the increase, and the integument of those sacs al- 
ready very thin, appeared too likely, at some moment, to give way 
suddenly, and in the absence of proper assistance, might bleed dan- 
gerously or fatally. This contingency was the more to be apprehend- 
ed, inasmuch as the sacs were observed to be always greatly distend- 
ed, and of deep colour, during the fits of epilepsy. 

On the other hand there were considerations of a negative kind as 
to the success of an operation, which greatly abridged the ground of 
expectation or dependance on such a mean. Admitting the palpable 



Wright's BaltiTnore Alms-house Reports, 93 

superaction, and the varicose state of the arteries on the right side of 
the head, as the possible origin of the epileptic phenomena, or if not 
the source of the affection, by all probability a cause of exasperation, 
and an impediment to its cure, was it certain, or likely, that tying 
one, or even both carotids, would afford sensible, or permanent re- 
lief, in the true seat of irritation and embarrassment leading to epi- 
lepsy? Was the state of superaction and dilatation confined to the 
external carotid distribution? or was it not greatly to be suspected, 
that the internal carotid branches were also the subjects of preterna- 
tural action, and probable varix enlargement. If so, the vertebral 
anastomotics within the head were sufficient to supply all the conges- 
tive derangement required to sustain and perpetuate the epileptic 
contingency. 

This patient had been almost two years in the house suffering at- 
tacks of epilepsy, at intervals seldom exceeding four weeks; her ge- 
neral health during the time was very much the same. The only me- 
dical regimen consisted in the practice of such depletion, by general 
bleeding, as the health of the common functions permitted, simple 
diet, and abstinence from laborious employment or undue exertion. 
But little change was visible in the state of the patient; the tumours 
on the head increased more by slow dilatation and thinning of their 
coverings, than by very obvious augmentation in their volume or ex- 
tent. Attacks of epilepsy were renewed, with various force, in dif- 
ferent paroxysms. 

In July, 18S0, the patient was attacked by what at first seemed 
one of her usual severe head-ache's, followed by epileptic invasion — 
but which, instead of passing off as before, by slow revival of con- 
sciousness, &c. glided into a train of symptoms resembling profound 
encephalitis. She became delirious for a time, soon lethargic, and 
fell into deep stupor, ending in death after twelve hours duration; 
third day after seizure. 

For the purpose of tracing the vessels, and for preservation of the 
parts, as a morbid specimen, it was determined to fill the arteries of 
the head with the common injection. A pipe was fixed in the root of 
the aorta, the descending trunk and the subclavians closed by liga- 
ture, and the injection passed, until from the quantity thrown up, and 
the distended state of the superficial vessels, the arterial system of 
the head was supposed to be fully injected. Although the branches 
of the temporal artery were filled in all its ramifications, the main 
purpose of the injection had wholly failed; not a particle of the injec- 
tion had entered the sacs on the head, with which the artery appear- 

9* 



94 y^vighi^s Baltimore Alms-house Reports* 

ed to communicate freely during life, imparting the fullness and pul- 
sation tiiej then possessed.* A few only of the smaller cysts in the 
tract of the middle temporal branch were raised up to the knotted 
form in which they appeared before death. The large pouches at the 
angle of the eye, on the orbital ridge, the top of the os frontis, and 
over the naso-frontal junction, were flat and empty. The total failure 
by the injection could only be explained on the presumption, either 
that the communication of the temporal branches with the cysts on 
the forehead had been by very small channels, which became ob- 
structed by coagula after death, or else that the great pouches had 
not received their fullness and pulsation directly from the temporal 
branches, as was supposed. The latter conclusion appeared most 
probable, and at the same time pointed to the veins as the route of 
communication with the now empty cysts. This conjecture was 
realized on trial. When a pipe was fixed in the superficial cervical, 
the trunk of the facial or angular, in the neck, and the injection 
pushed on, in a moment every sac was swelled out to the size and 
shape presented in life. All the cysts were filled, the pristine form 
accurately developed, and the external resemblance to the living state 
completely restored. The whole character of the local affection now 
appeared to be changed. Instead of a specimen of arterial varix, or 
anastomotic aneurism, for one of which, (or rather a compound of 
both,) the case had passed with all examiners, injection appeared to 
have revealed an example of morbid dilatation in the venous system, 
anomalous by the fact of immense varicose development in the capil- 
lary series, the venous radicles of that system. It proved afterwards 
that the case was of complicate character; and that while the more 
prominent forms of vascular tumour were really in a part of the ve- 
nous capillaries, the arterial series of the head had participated large- 
ly in the process, both of general and special dilatation. Definite ar- 
terial enlargement, (varix,) was as plainly marked, and scarcely less 
matured, in parts of the carotid distribution, as the venous varices 
just described. Arterial and venous developments were equipon- 
derant. 

The tumours on the forehead as now reformed by the matter of in- 
jection, were about the size of walnuts, and appeared to be made up 



* It ought to have been mentioned, in describing the cysts, that deep and 
strong pressure on the right carotid constantly subdued the pulsation in them, 
to a great degree, and when the pressure was forcible enough to shut the ar- 
tery in the neck, it extinguished all movement in the sacs, though they still re- 
mained full. 



Wright's Baltimore Alms-house Reports, 95 

by dilatation and anastomosis of the deepest subcutaneous veins; for 
above each tumour was spread a dense plexus of small veins, finely 
injected, and overlaying the tumours as a vascular arch or web. The 
large tumours were closely applied to (lie cranium, and so firmly at- 
tached in their place as to seem imbedded in the bone within the area 
of their base. In some of them this was found to be the fact: by 
pushing a commoa pin obliquely through the margin of the tumours, 
it penetrated the outer table of the cranium with great ease — the re- 
sistance by the bone not exceeding that of a piece of dried bladder; 
part of the cysts containing the wax were evidently inserted into the 
cranium as deep as the middle structure, latticework, of the skull. 
The rough and incavated feel of the bone within tlie limits of those 
tumours, which was discriminated by pressure during life, was thus 
explained. 

The arteries of the opposite sides of the head were in a very differ- 
ent state. Those of the neck were enlarged on both sides, but the 
common trunk of the right much more voluminous than its fellow of 
the left.* The most palpable inequality of size, however, in the two 
sets of vessels, was found in the branches of the external carotids. 
The right superior thyroid was as large as a crow-quill, and though the 
sublingual and facial were under natural size, the occipital again 
rather exceeded the ordinary volume of the common carotid. The 
temporal was ?nore than twice the size of the same vessel on the left 
side, and the branches of the former exceeded those of the latter, in 
the same ratio, (twofold,) both in number and size: the whole right 
side of the head, in fact, was ovei spread by a coarse web of large 
tortuous vessels, connected by frequent anastomoses. In only one 
point on the surface of the head did the present state of the arteries 
realize the idea which had been formed of their condition during life. 
About the middle of the posterior temporal branch, was a tumour or 
knob, the size of a small marble, formed by the abrupt dilatation of 
the lumen of the artery, now filled up and defined by the matter of 
injection. This was a solitary exhibition of true arterial varix in the 
set of arteries which had been supposed to betray numerous and large 
varicose developments. The actual state, then, of the external ar- 
teries of the right side of the head was nearly universal dilatation, 
but that change general and equal, (proportionate,) every where, with 
one point only of extra or special enlargement. 



* The right carotid, one inch above the innominatum, measured one inch and 
five-eighths in circumference; the left, at the same point in the neck, one inch 
and one-eighth. 



96 Wright's Baltimore Alms-house Reports. 

It appeared probable that the process of dilatation was not confined 
to the external arteries of the right half of the head. When, by re- 
moving the globes from the orbits, the ophthalmics came into view, 
the relative difference of size was as remarkable in them as in the su- 
perficial vessels of the two sides: the right ophthalmic was more than 
twice as large as the left. On examination of the vessels within the 
head, it was found that the morbid development was proportionally 
much greater in the cerebral arteries than in those of the cranium. 
Both the carotid and vertebral members of the great basilar circle 
were astonishingly enlarged. The communicans of the right side was 
equal to an ordinary little finger, and bulbous in three places; a knob 
near the carotid root of this trunk was as large as a musket-ball. The 
basilaris was rather more than an inch in circumference, and the right 
vertebral, immediately on rising up to meet its fellow, swelled out 
into a pouch, which, filled by the injection, was larger than any other 
of the tumours or knobs in the basilar series. The left communicans 
was enlarged, but much less so than the right, and it also exhibited 
points of particular or definite increment of the saccular form. Thus 
the arteries of the basis cerebri, besides being generally increased in 
size, were also eminently varicose at many points: the whole circle, 
and its principal branches, were singularly tortuous, anastomotic, 
and knotted. 

The condition of the arteries of the brain confirmed the surmise 
about their state which, during the life of the patient, had been urged 
against the probability of benefit by operating on the right carotid. 
The extent and relations of the vascular dilatations within the head, 
rendered it plain that the morbid excitement, or congestions to which 
they were instrumental, were unsusceptible of counteraction by any 
means short of total interception of all the channels by the neck. 
Both the carotid and vertebral members of the basilar circle were di- 
lated and varicose, and every where accessible to the current coming 
in at any point of the circuit. Whether the relative greater advance 
in change of capacity in the arteries within the head, than in those of 
the external carotid system, is to be taken as proof of prior departure 
from the normal state by the former, can only be conjectural: neither 
would the settlement of that question determine whether the epileptic 
state of the patient was the cause or the consequence of degeneration 
in either set of vessels. The time of origin of such change in the ce- 
rebral arteries would remain indeterminate, and the patient herself 
never was able to realize whether the fits preceded the tumours on 
the head, or followed their appearance: she supposed them to have 
taken place much about the same time. 



Wright's Baltimore Jllms-house Reports. 91 

The tone of vascular action in this case had been found habitually 
above the par of natural excitement. The pulse was always sharper, 
harder, and more frequent than is common in healthy there was also 
a perceptible thrill of the aneurismatic kind to be felt in all the prin- 
cipal trunks, even of the limbs. The en Ionic character of action had 
become constitutional, and was participated by the vascular series 
every where, and that habit, the usual forerunner of change of capa- 
city, was marked by its common results. The action of dilatation 
was traceable in most of the greater channels of distribution; but it 
was in the right carotid, and its branches, that superaction and dila,- 
tation were prominently displayed. For this speciality of morbid ac- 
tion and change it is difficult to find an explanation. Enlargement 
was regular, uniform, and proportionate tlirough the series, from the 
root in the innominatum to the terminal branches, yet 1 he arterial tis- 
sue seemed every where natural — no form of disease or decay in the 
texture of the coats. 

Another phenomenon presented by this case is of difficult solution. 
It is interesting to know the cause of pulsation so distinct and con- 
stant in the sacculated extremities of the facial or angular veins, the 
superficial veins of the forehead. Was the pulsation at the points in 
question the effect of successive impulses commencing at the heart, 
whose momentum was propagated reversely through the descending 
blood, or the result of a plethoric state of the whole venous system of 
the head, produced and maintained by habitual overaction of the heart 
and cephalic arteries? The more distinct statement of those questions 
would be, first, whether from excessive action of the heart, the ven- 
tricles particularly, the return blood of the head was in some degree 
checked or intercepted at the right auricle, and by the same forcible 
contractions a successive movement of repercussion or undulation 
was imparted to the column of fluid resting there, sufficient to be 
sensible or to give pulsation in the extreme vessels. If pulsation in 
the primary veins could be thus renewed in accordance with succes- 
sive reaction, or a certain momentum thrown back by the ventricles, 
then the operation of the same power would serve to explain the pri- 
mary change of condition, or the abnormal developments which those 
vessels had undergone at their extremities. That strong excitement 
or overaction of the heart may cause a degree of sensible repercussion 
in the descending venous series, appears to be established, if the 
statements are credible which we have on respectable authority, viz. 
that in high irritation of that organ all the superficial veins of the 
neck have been found beating visibly and palpably in concert with 



98 Wright's Baltimore Jilms-house Reports. 

the pulse. (Hall on Vascular Irritation.) The second branch of this 
question, is whether continued overaction of the heart and arteries 
was capable of producing a plethoric state of the brain, with such 
remora in the sinuses and venous system of the head, internal and 
external, as would occasion the momentum of the blood entering by 
the arteries to be communicated to the whole mass of fluid delayed 
in its return, and thus to fall with a special shock on the extreme 
veins. If the brain be incompressible, its venous system engorged, 
and the arteries of the head in full, or superaction, as the blood en- 
ters with pulsation, the stroke, in the given state of the veins and si- 
nuses, must be every where imparted to the fluid of that system, giv- 
ing a correspondent movement or successive undulation, terminating 
at the venous roots or origins. The sinuses, by their capacity, figure, 
and defence from strong membranes, are best fitted to resist impul- 
sion of their contents, and thus to direct it toward the extreme 
branches. Now, a shock of this kind, scarcely palpable among the 
minute and subdivided terminal series in their normal state, might 
become very sensible, if at any point or points, by dilatation and anas- 
tomosis, many of these radicles came to terminate in one or more 
cysts. Something analogous obtains in nsevi maternij the action of 
the small vessels of which those tumours are composed, would not 
be discriminated by the touch in their natural state, yet by some en- 
largement, and free communication in common receptacles or cells, 
pulsation becomes strongly revealed. 

Case VI. — imputation — Venous Hsemorrhage. — A man was re- 
ceived into the Baltimore Alms-house, October, 1830, with chronic 
inflammation, swelling, and suppuration of the left knee-joint. 
The local aftection resisted all treatment, topical and general, a 
deep sloughy fistula, communicating with the articular cavity, open- 
ed above the inner hamstring; symptomatic fever was urgent and un- 
remitting, diarrhoea supervened, and the patient fell rapidly toward 
a crisis of perilous lowness. In this state of things amputation was 
the only resort. The limb was separated as low down as the condi- 
tion of parts permitted. The weakness of the patient rendered it 
important to save his blood as much as possible, so that after dividing 
the bone, every artery was sought for and tied before the tourniquet 
was relaxed. When, after securing all the arteries that could be 
found, the tourniquet was loosed sufficient to show pulsation at the 
loops of the ligatures, not a single artery was sprung, nor a jet of 
florid blood visible, but a sudden gush of black blood from the great 
vein, rendered it necessary instantly to draw the tourniquet close. 



Wright's Baltimore Mms-house Reports. 99 

An attempt was then made to discover whether such compression as 
the stump might bear in dressing would be sufficient to command the 
flow through the vein. For this purpose the soft parts were compre- 
hended in both hands, and very firmly braced around the bone, after 
which the tourniquet was again cautiously loosed. The moment the 
ligature on the artery was observed to feel the returning current, the 
blood of the vein spouted in full stream to the distance of four or five 
inches from the face of the stump, unchecked by the closest grasp 
which could be made by the hands. It was now evident that ligature 
of the vein was indispensable. Its extremity was carefully insulated 
from every thing around, drawn out and tied. On now loosening the 
tourniquet, it was found that the hsemorrhagic disposition was as- 
sumed by all the secondary veins. Not one, but eight or ten streams 
of venous blood were projected to the distance of four or five inches, 
and in defiance of all compression, short of the tourniquet, continued 
to maintain their full projectile currents. Aware that partial com- 
pression by the band around the limb favours venous hemorrhage, 
the tourniquet was thrown for a moment completely free, the limb 
raised vertically, and firmly grasped around the stump. Nothing was 
gained; the rush from the veins was undiminished and continuous, 
precisely as from arteries. It finally became necessary to apply liga- 
tures to every vein of any size in the stump. In this manner eleven 
veins were tied up. We were for many days far from unconcerned 
about the possible consequences of the measure to which we had been 
forced, but the case went on without a single bad symptom which we 
could refer to the ligature of the veins. Owing to great exhaustion 
of the patient by symptomatic fever and diarrhoea contracted prior to 
operation, the parts about the stump did not cohere well, and a gleety 
suppuration for some time kept the wound open — indisposed to heal, 
and finally involved exfoliation from the end of the bone; but there 
was at no time signs of phlebitis, local irritation, or constitutional 
disorder, in any manner different from what might have happened 
had no vein been tied. 

This was the first occasion among numerous amputations in which 
I had found it necessary to treat veins as arteries, and, notwithstand- 
ing the apparent harmlessness of the practice in this instance, would 
never stop veins by ligature where it was possible to avoid their em- 
ployment. 

Baltimore, Jiugusf, 1831. 



100 Foulke's Case of Traumatic Tetanus. 

Art. VIII. Case of Traumatic Tetanus^ successfully treated. By 
Antrim Foulke, M. D. of Montgomery County, Penn. 

To the Editor of the American Journal of the Medical Sciences. 
Dear Sir, 
My friend, Dr. Antrim Foulke, a most respectable and excellent 
physician, of Montgomery County, has communicated to me the par- 
ticulars of a very interesting case of tetanus, which I saw with him 
during the convalescence of the patient, and which, from the circum- 
stance of tetanus, from a wound, being very seldom cured, deserves 
to be recorded. You will oblige me by inserting it in the Journal. 

Truly yours, 

W. GIBSON. 

Noah Snyder, aged twenty-four years, a robust and muscular man, 
of a sanguine temperament, on the 25th of July last received a wound 
in his leg from a cradling scythe, by which ihe posterior tibial artery 
was divided. The haemorrhage was profuse and obstinate, but ulti- 
mately yielded to compression^ and notwithstanding the prostration, 
which was in the first instance alarming, the patient did well, the 
wound healed kindly, and no untoward symptom appeared until Au- 
gust the 17th, when he was seized with unequivocal symptoms of 
tetanus, the spasms commencing in the injured extremity, and pro- 
ceeding along the whole course of the spine and neck, producing a 
complete incurvation of the body. The jaws, though not entirely 
closed, were so rigid as barely to admit the introduction of a tea- 
spoon. The contortions of his face were truly horrible, and degluti- 
tion and articulation were eflected with great difficulty. 

I immediately administered a large tea-spoonful of laudanum, had 
the dressings removed from the wound, and ol. terebinth, applied, 
and frictions of the same to his spine. Opium, in combination with 
camphor, was given in large doses at short intervals during the night, 
which, together with the ^^qq administration of brandy, produced to- 
wards mornino; a considerable abatement in the violence of the 
spasms, and a state of comparative tranquillity. The medicines were 
continued, but in smaller doses, and at longer intervals. Towards 
the evening of this day, as the spasms recurred with their wonted 
violence and frequency, the same remedies which had been used the 
preceding evening were resorted to, and with a similar effect. He 
was then left under the almost uninterrupted influence of stimuli for 
the three succeeding days, but the spasms, though they at no period 



I 



Turnbull on the Modus Medendi of Emetics. 101 

during that time attained the same general and alarming violence, 
still continued to recur at longer or shorter intervals. 

Finding that nothing had been, or seemed likely to be, effected by 
the stimulants alone, and dreading the state of exhaustion and collapse 
which such powerful and long-continued excitement must superin- 
duce, I resolved to endeavour to break up the chain of morbid action, 
by making a new constitutional impression. Accordingly, on the fifth 
day from the first attack of the disease, I commenced giving him ca- 
lomel, in conjunction with the remedies previously used, and conti- 
nued it until a complete ptyalism was produced. This was not at 
first attended with any very manifest amendment of the symptoms, 
but in a few days, though the spasms continued to excite uneasiness 
and alarm, they were much reduced in violence, and were, for the 
most part, confined to the injured extremity. The patient continued 
in this situation for several days, when I commenced giving him as- 
safoetida in substance, and in large quantities, which was promptly 
and unequivocally beneficial, for in four days from its first exhibition 
the disease was entirely removed. 

Although I believe the most active and vigorous use of stimulants 
to have been entirely indispensable, as auxiliaries in the treatment 
of this case, yet I am persuaded that the breaking up of the morbid 
condition is clearly attributable to the agency of the mercury. The 
prompt and effectual influence of the assafoetida, in the latter stages 
of this case, leads me to entertain a high opinion of its antispasmodic 
virtues v/hen administered in very large doses. 

Montgomery County^ Pa. Sept. 1831. 



Art. IX. Observations on the Modus Medendi of Emetics. By 
RoRERT J. Turnbull, M. D. of Charleston, S. C. 

W E do not seriously indulge the hope, that there is much on the 
subject of emetics possessing the charm of novelty which has hitherto 
escaped the research of the profession. The extent of our present 
design, is rather to revive certain principles connected with the ope- 
ration of emetics upon the human system, which, though acknow- 
ledged by all as among the most fundamental of the healing art, are 
too often lost sight of by the regular routine practitioner — together 
with certain deviations from the ordinary mode of reasoning on this 
class of medicines, which, if possessed of no other merit, will at 
least be entitled to the claim of originality. 
No. XVII.— Nov. 1831. 10 



10^ Turnbull oH the Modus Medendi of tlmetics. 

We cannot, however, but flatter ourselves, that a more extended 
view of the phenomena which evince themselves upon the exhibition 
of emetic substances, will conduce much to arrest the progress of 
diseases of associated action, which ought, and can only be counter- 
acted bj agents of equally associated effects upon the system. 
Fever, a disease universal in its operation upon the system, impli- 
cating every organ, every tissue, and every system of vessels, is only 
to be subdued by remedial agents equally universal in their ef- 
fects; and in searching the materia medica for a class of medicines 
capable of accomplishing these indications, none presents such claims 
to our consideration as the various emetic substances, distributed 
through the vegetable and animal kingdoms. In combating fevers 
successfully, the practitioner must pass over the less important 
and primary action of emetics, to wit, the ejectment of the vitiated 
contents of the stomach, and base all his hopes of success upon 
those secondary effects upon the system, brought about by the de- 
pressed condition of the heart and arteries, dependant upon that in- 
explicable bond of union between distant parts of the system, deno- 
minated sympathy^ and by which depressed condition of the circula- 
tory organs we effectually controul inordinate action in any and 
every part, whether manifested in the form of simple excitement, or 
intense inflammatory action. 

However, to one conversant with the high encomiums passed upon 
this class of medicines by the various authorities of the materia me- 
dica, it cannot but be evident that the practice of the present day is 
not based upon those salutary principles, viz. the secondary action 
of emetics, which characterized the practice of the practitioners of 
the past generation — that a revolution has obtained in the therapeu- 
tics of disease which has substituted a mode of treatment widely dif- 
fering from that of our predecessors — and that the secondary effects of 
emetics have not only been lost sight of, but that the class of cathar- 
tic medicines have in a great measure superseded the use of emetics. 
It is not, however, a little singular, that the practice and theory of 
the day should be at variance. While our text-books teem with reci- 
tals of the wholesome and salutary effects of emetics, acknowledge 
their varied and extensive operation on the system, justly commend 
them as primary agents in combating the numerous diseases " that 
flesh is heir to;" still, by a strange inconsistency, they are much ne- 
glected, not unfrequently condemned on account of some hypotheti- 
cal consideration, and when prescribed, it is usually with views so 
limited, as in a great measure to render them, if not nugatory, cer- 
tainly of extremely limited advantage. 



i 



Turnbull on the Modus Medendi of Emetics, 103 

Though the writers of the materia medica have ably portrayed the 
primary and secondary effects of emetic substances when acting upon 
the human system, he who has concentrated his observation upon the 
practice of the profession relative to the employment of emetics, will 
readily perceive the necessity of conceding, that they have in ^ great 
number of diseases been rejected as dangerous, and even when ac- 
knowledged as legitimate resources of the art, have, in a majority of 
cases, been resorted to with the most limited views, simply prescribed 
as an evacuant of a stomach morbidly oppressed with accumulated 
ingesta or vitiated secretions, at once losing sight of those various 
secondary phenomena which invariably supervene upon the introduc- 
tion of emetic substances into the stomach. Such is the extent of 
sympathy which exists between this organ and all other parts of the 
animal machine, that this viscus has, with no less propriety than 
beauty of expression, been termed the centre of sympathies. To at- 
tempt fully to trace the causes of this bond of union between the re- 
motest parts of the system, might be involving ourselves in a labyrinth 
of cause and effect too intricate to engage the attention at present; 
suffice it, that we now only advance a theory, which, though deemed 
inadequate to explain this singular and extensive connexion of the 
various remote parts of the system, may be a mean of leading other 
minds to a more thorough investigation of a fact thus far deeply in- 
volved in obscurity. 

lu treating this subject we shall divide the numerous sympathies 
which manifest themselves, into direct^ and indirect. Direct sympa- 
thy is that which exists between the heart and stomach, and we shall 
denominate it the gastro-cardiac sympathy. 

To give any plausible conjecture of this connexion between these 
two important organs — the centres of the circulatory and digestive 
systems, it will be necessary to resort to another fact, which, though 
somewhat hypothetical, nevertheless carries with it so much proba- 
bility, that we think it will be conceded by all. 

We would maintain, that every organ, for the performance of its 
healthy functions, is dependent upon the brain for a certain portion 
of nervous fluid, vis nervea, by virtue of which it performs its ordi- 
nary functions. 

It is well known, that inordinate muscular action, to accom- 
plish which the muscles must be constantly supplied with nerv- 
ous energy, greatly impedes the digestive process. Great mental 
exertion, by withholding that vis nervea, which is essential to the 
various organs for the performance of their respective functions, 



104 Turnbull on the Modus Medendi of Emetics. 

and concentrating it for purposes of great mental action, necessarily 
impairs these organs, thus robbed of their due proportion of this es- 
sential fluid. Great mental emotion, such as grief, fear, joy, all exert 
an injurious tendency upon the other organs of the system, by con- 
centrating this fluid in the brain. To this abstraction of the vis ner- 
vea by the cerebral mass from the other viscera, may be referred the 
whole catalogue of diseases incident to persons of sedentary habits. 
The stomach, and in short, the whole digestive apparatus being thus 
extraordinarily robbed of its primum mobile, viz. the vis nervea, is 
still called upon to perform its ordinary avocations in the ordinary 
manner; that it should not promptly respond to this unreasonable de- 
mand, is not singular; that it should consequently perform its func- 
tions in an irregular manner, first, by functional derangement of the 
primse viae, as evinced by acidity, flatulence, cardialgia, &c. and 
after by chronic, gastric and hepatic inflammation, is the natural con- 
sequence of the abstraction of this fluid; thus clearly proving that the 
health of the individual ultimately depends upon a regular and just 
distribution of nervous energy to the various organs of the body. 

Now, by a resort to the old and just maxim of "ubi irritatio, ibi 
fluxus," may we at once give some plausible conjecture as to the va- 
rious phenomena which are manifested in the circulatory system, when 
an emetic substance is presented to the stomach. By an acknowledg- 
ed law of the animal economy, every organ is endowed with the power 
of instituting certain processes, tending to avert any causes which 
threaten the interruption of the performance of its functions. The 
sensitive fibres of the iris immediately contracts to protect the deli- 
cate retina from an intense light, which by over-stimulation would 
produce organic derangement in this delicate tissue. The intestines, 
by virtue of the same sanative principle inherent in them, by an in- 
creased peristaltic action hurry along the tract of the alimentary 
canal any substance incompatible with its ordinary and healthy ac- 
tion, and thus it is that the stomach when oppressed by the presence 
of an emetic substance, would appear, when about to collect its 
energies, to call upon the neighbouring organs to lend their aid for 
the ejectment of the offending matters. By the immediate response 
of the various organs, there is concentrated in this viscus an unusual 
degree of nervous power, to the abstraction of it from every other 
part of the system. The heart, thus deprived of its ordinary quan- 
tity of nervous energy, and feeling tlie want of that portion which has 
been determined to the emetic oppressed stomach, necessarily per- 
forms its functions in an enfeebled manner, and a corresponding en- 



Turnbull on the Modus Medendi of Emetics, 105 

feebled systole and diastole is the result, as evinced by the paleness 
of the countenance, indicative of diminished action in the capillary 
vessels of the face, and as rendered more evident by an examination 
of the circulatory system, through the medium of a soft, feeble, or 
frequent pulse, &c. which facts we think unequivocally establish the 
existence of that direct sympathy between the stomach and heart, 
which we above termed the gastro-cardiac sympathy. And it is by 
the intervention of this one direct sympathy, that we account for all 
those phenomena which are presented to our observation under the 
term sympathies; numerous indeed, by virtue of that unlimited con- 
nexion which exists between the heart and every part of the animal 
machine. As there is no organ whose inmost recesses are not mo- 
mentarily subjected to the vivifying influence of the contents of 
the heart and arteries, it will be apparent to the most casual ob- 
server, that in the exact ratio that we can controul the action of 
these, we shall produce corresponding changes in every portion of 
the system; and thus do we illustrate those various phenomena which 
have obtained the various appellations of gastro-cutaneous, gastro- 
cerebral, gastro-hepatic, and gastro-pulmonic sympathies, as also in- 
numerable odiers, which might be muXiipYied ad infinitum — certainly 
to as many as there are parts in the animal machine. They might 
justly be enumerated from the most important organs to the ultimate 
Jibre which enters into the most delicate structure. To enumerate the 
most conspicuous of these, will, we feel assured, be productive of 
giving liberal and salutary views in the exhibition of emetics, which 
cannot fail to render our practice more successful, and, at the same 
time, confirm the confidence which our text books repose in this va- 
luable class of medicines. 

In pursuing our inquiries relative to indirect sympathy, the first 
that presents itself to our consideration is that which exists between 
the stomach and brain, under the title of the gastro-cerebral sym- 
pathy. This connexion between these important organs is made ap- 
parent |;o our senses by the syncope which supervenes upon extreme 
nausea, dependant upon an enfeebled, or perhaps a suspension of the 
capillary circulation within the cerebral mass, and this again de- 
pendant and enfeebled action of the heart, enfeebled by an undue 
determination of nervous fluid to the emetic oppressed stomach. It 
ought here to be remarked that these sympathies are reciprocal, the 
stomach being as often affected by impressions made upon the brain 
and the nerves derived from thence; the infliction of a blow upon the 
cranium, certain impressions made upon the olfactory nerves by dis- 

10* 



106 Turnbull on the Modus Medendi of Emetics. 

agreeable odours, the abstraction of blood, all exert an influence upon 
the stomach. 

Ever to have an attentive eye to this sympathetic connexion cannot 
but conduce highly to our success, when called to encounter inflam- 
mation in this important organ, whether proceeding from disorganiza- 
tion of its substance or its delicate meninges, or whether the result 
of simple excitement dependant upon increased vascular action. To 
controul inordinate action in this important organ, the earliest resort 
should be made to the use of emetics, after a copious evacuation of 
the circulatory system by the lancet, thus maintaining the advantage 
derived from the use of this instrument without further debilitating 
the patient by copious and repeated draughts upon the vital fluid. 

Of the existence of many other sympathies between the stomach 
and other organs, there exists most ample testimony. These have 
received appellations indicative of the various organs which they con- 
nect, as for instance, the gastro-renal, the utero-gasiric, the cysto- 
gastric, &c. all evincing themselves under certain circumstances, 
such as the irritation dependant upon urinary calculi in the bladder 
or ureters, the uterine contents during the period of gestation, the 
accumulation of urine in the bladder, all of which exert an influence 
over the stomach, inducing all the symptoms of gastric irritation, 
varying from the slightest nausea to the fullest vomition. 

After having thus pointed out the universal sympathy which exists 
between the stomach and every other part of the system, may we 
not ask what organ is diseased, in which symptoms of preternatural 
actio?! are manifested, and emetics not imperiously demanded? If, 
as pathologists teach, inflammation is seated in the capillary system 
of vessels, then are emetics, by virtue of their peculiar sedative ac- 
tion upon these vessels, controlling both the velocity and quantity of 
the circulating mass within them, one of our most powerful antiphlo- 
gistic agents. The heart no sooner perceives that a portion of its 
ordinary nervous energy has been abstracted, than enfeebled systole 
supervenes. An enfeebled contraction of this organ necessarily in- 
volves the supposition of diminished action of the whole arterial sys- 
tem; those recesses which are most remote from the centre of the 
circulation first feel the absence of its ordinary stimulus, and diminish- 
ed action in these parts, before preternaturally excited, is the con- 
sequence. 

That such diminished action of the capillary system of the internal 
organs does take place, we infer from the phenomena presented to 
us by those which are external. The pale and shrivelled countenance, 



TurnbuU on the Modus Medendi of Emetics. 107 

dependant upon diminished action of the capillary vessels of the face, 
occurring synchronously, and even before the supervention of nausea, 
forcibly teaches us that an analogous condition must obtain throughout 
the system, in the internal as well as the external organs. 

Of the sedative effects of emetics upon the capillary system, there 
exists other testimony than our own observations. Experimentalists 
have ascertained, that in the exact ratio of the emetic substance being 
urged upon the stomach, is the degree of the diminished action ex- 
tended; retrograding from the capillary system to the next sized set 
of vessels, and again to those of a still larger diameter, until even- 
tually in the smaller animals it has extended itself by this retrograde 
movement to the heart itself, whose action it has eventually extin- 
guished. 

Thus deprived of the vivifying influence of the blood and with it a 
certain portion of the vis nervea, which gives to the diseased organ a 
morbidly tonic condition, a universal relaxation pervades the system, 
eliciting the organs thus affected to pour out their locked up secre- 
tions. 

Such then are the additional views, which ought to occupy the 
mind of the physician when prescribing emetic substances. In all 
diseases of associated action, it is to their effects upon those organs 
embraced in the term secundx vias, that we must look for success. 
In the idiopathic pyrexia, by virtue of their universal relaxant pro- 
perty, they become one of our chief agents in arresting the progress 
of this class of diseases. In fever, dependant upon inflammation, 
, or some other irregularity of the capillary system of vessels, which 
maybe said to constitute the parenchyma of an organ; the exhibition 
of an emetic stands second only to the use of the lancet. As there 
cannot exist great local determination, without a corresponding accu- 
mulation of nervous energy in a part, the beneficial ettect of an emetic 
will be strikingly observable in the fact, that having diminished the 
quantity of vital fluid circulating within the part, an abstraction of a 
portion of the morbidly accumulated vis nervea is the result, and re- 
lief from local pain is a further consequence. 

When thus dwelling upon the secondary action of emetics, we 
would not wish to have it understood that we in any degree wish to 
invalidate the confidence which is justly reposed in this valuable class 
of medicines, even when prescribed with a view to their primary ac- 
tion upon the system, viz. for the ejectment of accumulated ingestion 
or vitiated secretions, preparatory to the exhibition of other medicines, 
designed to operate upon the alimentary canal. Such preparation 
being sometimes absolutely necessary, owing to a preternatural irri- 



108 Turnbull on the Modus Medendi of Emetics. 

tability of the stomach. The advantages of relieving a stomach thus 
oppressed, are too evident to require comment here. None feel the 
advantages to be derived from the primary action of emetics upon the 
alimentary canal and coUatitious viscera, more than ourselves. 

As cathartic agents, this class of medicines present urgent claims 
upon the attention of the profession. They exert a twofold operation 
upon the system. Independent of their stimulant operation upon the 
alimentary tube, producing copious discharges of feculent matter, 
highly coloured with the hepatic secretion, first elicited by the 
universal relaxation of the system, and after extorted from the 
liver by the combined pressure of the diaphragm and abdominal 
muscles, during the act of vomiting. A portion of this bile, es- 
caping into the duodenum, and thus being out of the reach of the in- 
verted action of the stomach, passes through the whole tract of the 
alimentary canal producing its peculiar cathartic action. Indepen- 
dent of this highly remedial operation upon the alimentary canal 
and coUatitious viscera, antimonials managed as cathartics, presents 
other and higher claims to the consideration of the profession, which 
ought to give them a decided preference when prescribed in febrile 
diseases. We again allude to their secondary operation upon the 
system, to wit, their controul of the action of the heart and arteries^ 
this while it effects the primary object of alvine evacuation, subdues 
inordinate action in every part; whether it be in the encephalon, as 
evinced by head-ache, intolerance of light, or in the suffused and 
muddy appearance of the eyes; whether in the pulmonary organs, as 
declared by cough, stricture, or limited respiration; whether the in- 
flammation be seated in the parenchyma of the liver or in the serous 
tissues investing it; in short, by virtue of diminished cardiac, arterial, 
and consequent venous action, in whatever part of the system, how- 
ever remote, or inordinate it may exist, it cannot fail immediately to ex- 
perience the sedative effects of antimonial emetics, administered with 
the double view of producing their emetic and cathartic operation. 

We shall now cursorily glance at one or two diseases, in which 
emetics may be administered with great advantage, but more espe- 
cially with a view to their modus medendi in these complaints. 

If, as we believe, dropsy be dependant more frequently upon inordi- 
nate capillary action, resulting in the deposit of serous secretion, rather 
than upon diminished action of the absorbent system of vessels, then 
would our views of controlling the circulation within these vessels, 
through the medium of the gastro-cardiac sympathy, prove most ap- 
plicable. The exhibition of emetics in this disease, will, however, 
much depend upon the condition of the pulse. As desirous as we 



Turnbull on the Modus Medendi of Emetics, 109 

are for a more general use of antimonials, upon more extensive views, 
we cannot subscribe to the position that, as they promote absorption, 
that they are therefore appropriate in all forms of this complaint. It 
is only in those cases in which there is observable an acceleration of 
pulse, not amounting to fever, that we deem them admissible. In a 
contrary condition of the arterial system, as when the disease super- 
venes upon old and worn out constitutions, as indicated by a feeble 
and frequent pulse, it is evident that an emetic cannot otherwise than 
depress a system, already requiring artificial support. It is not ne- 
cessary that this excitement be manifested by the pulse. Inordinate 
capillary arterial action and consequent serous effusion may exist 
without involving the circulation in the larger system of vessels. 

These opinions have been adopted, because we think that obser- 
vation has taught us that the absorption and discharge of the fluid 
collected in the peritoneal cavity, is never effected until such time 
as the hydragogue medicines resorted to, have, by their evacuant ope- 
ration, subdued that excited condition of the pulse, upon which the 
disease, in a majority of cases, essentially depends. By the profuse 
serous evacuations, and a consequent diminution of the circulating 
mass within the exhalent arteries of the intestines, a revulsion is pro- 
duced, and the tide of the circulation is reversed. Instead of a pre- 
ternatural afflux to the capillaries of the peritoneum, it now flows 
to the capillaries of the mucous membrane of the intestines, which 
in obedience to the stimulant operation of medicine, pour out their 
serous contents, thus substituting an artificial excitement of the ca- 
pillaries of a mucous, for the more dangerous inflammatory condition 
of those of a serous membrane. Such, do we believe, is the modus 
medendi of ordinary hydragogues. To their evacuant or depleting 
powers, do we attribute the beneficial results consequent upon their 
exhibition. 

If the above reasoning be correct, we feel confident that an anti- 
monial cathartic would be decidedly preferable to all other cathar- 
tics, by virtue of its twofold operation upon the system. It promises 
to answer the double indication of producing revulsion of the circu- 
lation, by the profuse serous evacuations which are consequent to its 
exhibition, as also to controul the circulation within the peritoneal ca- 
pillaries by virtue of its sedative action upon the heart and arteries, 
thus obviating that condition in this system of vessels, upon which 
we have supposed the serous deposit to depend. To this artificial 
inequilibrium of the circulation of the arterial and absorbent systems, 
brought about by the diminished action of the former, do we refer 
the apparent direct stimulant eff*ects of the latter. Emetics do not 



110 Turnbull on the Modus Medendi of Emetics. 

promote absorption, bj directly stimulating this system of vessels, 
but rather accomplish the removal of effused fluid, bj arresting its 
secretion — bj controlling the circulation within the diseased capil- 
laries of the parts affected. 

An investigation into the pathology of dysentery, in the highest de- 
gree corroborates the use of emetics^ all the symptoms declaring the 
existence of intestinal inflammation, and consequent spasmodic con- 
striction. Of the various theories which have been promulgated as 
to the pathology of this disease, each may be made to countenance 
the above pathological exposition. Whatever theory, therefore, we 
may adopt, we can substantiate the utility and modus medendi of eme- 
tics. If with Sydenham, we believe it to be the result of checked 
cutaneous transpiration^ if with C(elius Aurelianus, Akenside, 
Stoll and Richter, we admit it to be a rheumatic affection of the 
digestive tube; if with Cullen, we believe it to be a catarrh of the 
intestines; if v/e believe it to consist in spasm of the colon, the colo- 
nitis of Ballingate, whichever of these opinions we adopt, the prin- 
cipal indications are, to relieve spasmodic constriction, to determine 
to the surface, and to take off local inflammation hy controlling the ca- 
pillary circulation. In accomplishing these indications, a knowledge 
of the secondary operation of emetics becomes of the highest import- 
ance. Of these various theories, we believe that which makes the 
disease to consist in irflammation, and consequent spasm of the intes- 
tinal tube, to be most in accordance with the truth. To obviate this 
morbid condition of the intestines, the relaxant properties of emetics 
promise much. Their sedative action upon the capillary system of 
vessels, controlling the circulation within the inflamed parts and the 
relaxation which must always be a concomitant of the abstraction of 
blood from the capillaries of the inflamed part, conspire to give themi 
claims to the utmost confidence. Spasm must be considered, in a 
large majority of cases, as dependant upon an accumulation of ner- 
vous energy in a part. In whatever part an accumulation of the vital 
fluid occurs, a preternatural accumulation of the vis nervea is the 
natural censequence. To take off* this preternatural determination 
of the circulatory and nervous fluids, by creating an artificial centre 
of irritation, is the principal object in exhibiting an emetic in dysen- 
tery. With iheiv primary action, viz. the ejectment of contents of 
the stomach, we have little to do; their modus medendi is to be sought 
for in their sedative action vpon the capillary system of vessels induced 
by the determination of the circulatory and nervous fluids to the 
emetic oppressed stomach. 
From what has already been said, we feel that we may have been 



' TurnbuU on the 2iodus Medendi of Emetics. Ill 

anticipated in extending their use to all the remaining phlegmasiae. 
In all inflammations of the serous membranes thej exert a most re- 
medial influence, bj virtue of their sedative action upon the extreme 
vessels, and the more delicate the system of vessels, the greater 
power they appear to exert. Their highly remedial influence in oph- 
thalmia and erysipelas, in which diseases the vessels of the most de- 
licate tissues of the system are affected, viz. the conjunctiva and the 
skin, are corroborative of the assertion. 

We are not ignorant that erysipelas has been thought by the emi- 
nent Desault to be dependant upon derangement of the biliary sys- 
tem, and its cure essentially connected with the copious evacuations 
of bile, incident to the exhibition of an emetic. We difter, in toto, 
from this justly celebrated authority. We should be inclined to re- 
fer the preternatural secretion and consequent vitiation of the hepatic 
secretion, to some morbid condition of the capillary vessels of the 
liver and general system, rather than view the vitiated secretion as 
the cause of the primary derangement, and it is to the peculiar action 
which emetics exerts upon this system of minute vessels, that we are 
to look for the solution of their modus 7nedendi. If the morbid action 
consists in spasm and inflammation of these vessels, then we should 
point to the use of emetics as the most efficient means of producing 
universal relaxation, and consequent diminution of arterial capillary 
action. 

Enough has been said to induce the practitiener to extend the use 
of emetics to all the remaining phlegmasiae. In enteritis, peritonitis, 
cynanche trachealis, cynanche laryngea, and cynanche maligna, the 
most formidable of all anginose diseases, the use of emetics are in- 
dispensable. In all inflammations affecting the denser membranes, 
they become the most powerful auxiliaries of the lancet, but it is prin- 
cipally in the latter disease that their remedial agency is most con- 
spicuous. The rapidity with which the inflammation extends itself, 
and its proneness to pass into a state of mortification, imperiously 
demands that we resort to the use of emetics, whose action seems 
particularly directed against the inflammatory condition of the ca- 
pillaries of the mucous membrane lining the throat, whose excessive 
action and consequent mortification constitutes the danger of this 
truly formidable disease. 

That a prompt resort, and a repeated use of the lancet will ac- 
complish most of the indications for which we have recommended the 
use of emetics, is a fact which would seem to invalidate the impor- 
tance which we have endeavoured to attach to this class of medicines 
in treating the phlegmasia, if not otherwise explained. That the 



112 Turnbull on the Modus Medendi of Emetics, 

lancet is a direct sedative to the capillary system of vessels, by emp- 
tying the larger vessels of their contents, and tlius creating a deter- 
mination to these, which is effected at the expense of the capillary 
system, is generally admitted 5 and it would appear that a repetition 
of its use would effect the very indication for which we prescribe our 
emetic, viz. to controul the circulation within the capillary system, 
which, if it does not constitute, certainly is favourable to the exist- 
ence of inflammation. We do not wish for a moment to countenance 
the idea that we reject the use of the lancet. We rather resort to 
emetics as its most powerful auxiliary, and as instrumental in prO' 
trading that condition of the capillary circulation induced by the 
use of the lancet, without effecting an excessive expenditure of the 
vital fluid, which favours serous effusion, an evil which is also to 
be avoided. Though the lancet produces a change in the circulation, 
in which the tide sets from the seat of inflammation, viz. the extreme 
vessels to those of larger diameter, the system soon establishes an 
equilibrium, and the seat of irritation again becomes a point to which 
the circulation is attracted, until a repetition of its use again pro- 
duces a revulsion. To avoid this excessive expenditure of the vital 
fluid, we prescribe emetics, which effectually controul without dimi- 
nishing the quantity of the circulating mass, already so much reduc- 
ed as to render its further abstraction liable to be attended with dan- 
gerous consequences. 

With this exposition of our views of the pathology of dropsy, we 
pass on to say a few words to reconcile the great discrepancy which 
pervades the profession relative to the use of emetics in apoplexy. 
The weight of authority, we are well aware, is against their use, and 
the acknowledged pathology of the disease, which makes it to con- 
sist in a congested state of the cerebral vessels, would appear to give 
additional weight to the objecting party. A reference, however, to 
the phenomena which invariably obtain previous to the act of emesis, 
will in a great degree, invalidate the reasonings of those who oppose 
their use. The pale and shrivelled countenance, the frequent, feeble, 
and irregular pulse, the diminished capillary circulation, indicated 
by the paleness of the general surface, all tend to prove the fallacy 
of an assertion, based upon high authority, viz. that emetics ''have 
a direct tendency to increase the fulness of these vessels, (cere- 
bral,) by increasing the arterial and retarding the venous circulation." 
Now we rather think that it is susceptible of proof, that directly the 
reverse of this obtains. Previous to the act of vomition, there always 
exists a diminished action in the vessels of these systems by which 
both the velocity and quantity of the circulating mass is materially 



Turnbull on the Modus Medendi of Emetics, 113 

diminished in the cerebral vessels. To the sedative action of an eme- 
tic upon the heart and arteries and other circulatory organs, are we 
to look for the fact which can alone reconcile the discrepancy of 
opinion relative to the use of emetics in apoplexy. By virtue of the 
sympathy which exists between the stomach and heart, resulting in 
a diminished action of the latter, the afflux of blood to the head, is so 
much diminished as in a great measure to preclude the possibility of 
danger during the short period of emesis by preventing the free return 
of the circulatory mass through the venous channels. It is, then, by 
a reference to the sedative effects of emetics, previously to the act of 
vomiting, thereby controlling the cerebral circulation, that we think 
ourselves justitied in recommending the exhibition of this class of 
medicines as legitimate resources of the art in treating apoplexy. 

A few words upon the diaphoretic properties of antimonials we 
hope will not be deemed superfluous. In accomplishing this important 
indication, antimonials are singularly efficacious. By the universal 
relaxation which pervades the system when under nausea, relieving 
the morbidly constricted vessels of the surface, i\\\\^ eliciting the na- 
tural cutaneous transpiration; by the moisture and even profuse per- 
spiration which bedews the forehead, and even whole body, of the pa- 
tient, when in the act of vomiting, whose natural secretions have just 
before been locked up by febrile action; by the softness and coolness of 
the skin consequent to these attempts at vomiting; by these and other 
considerations, we should be disposed to give antimonials a decided 
preference, as diaphoretics, over that class of stimulant medicines, 
which, by increasing the circulation, extorts perspiration from the 
constricted capillaries of the surface. In the exhibition of the former, 
the spasm of these vessels is first subdued by the relaxation incident 
to nausea, before the attempt at vomiting, by increasing the circula- 
tion, force out cutaneous transpiration, thus removing all those fears 
which might justly be entertained when prescribing those stimulant 
medicines which break up spasm, without previously relieving the 
morbidly tonic condition of the cutaneous capillary system. 

As expectorants, the value of antimonial emetics are too generally 
acknowledged to require comment here, we shall, therefore, content 
ourselves with saying a few words upon their modus medendi. 

Directly stimulant to the stomach, and thus concentrating nervous 
energy in this viscus, an emetic becomes indirectly a powerful seda- 
tive to the rest of the system. By the intervention of the diminished 
action of the heart, a corresponding change is produced in the capil- 
laries, ramifying upon the mucous membrane of the bronchiae and pa- 
renchyma of the lungs. A diminished action in these vessels is an ap- 

No. XVIL— Nov. 1831. 11 



114 Turnbull on the Modus Medendi of Emetics, 

proximation to their natural and healthy condition, and mucous se- 
cretion is the result in a system of vessels whose action before was 
suspended or performed in a limited manner, owing to capillary 
spasm. To this indirect sedative power of emetics must be attributed 
the protean action of this class of medicines. As sialagogues, by re- 
laxing the salivary glands to that degree as to incapacitate them for 
the retention of their peculiar fluids. As emmenagogues, by relaxing 
the uterine capillaries, the morbidly tonic condition of which may 
frequently be regarded as the cause of the non-appearance of their 
peculiar secretion. As narcotics, by controlling inordinate arterial 
action, which favours the accumulation of nervous energy in im- 
portant organs, and especially in the brain, upon which that distress 
and anxiety peculiar to intense febrile action is dependant. As the 
system has approximated the natural and healthy condition, by the 
equalizing action of an emetic, or rather by its power of determining 
nervous energy from the oppressed organ to the stomach, we have 
witnessed corresponding changes in the feelings of the patient, vary- 
ing from mental and corporeal tranquillity to profound natural sleep. 
It now only remains for us to say something upon the mode of ad- 
ministering emetics, by which the greatest advantages are to be 
gained^ the ordinary manner of administering them being deficient 
in that principle of gentle, repeated, and protracted emesis, upon 
which success must chiefly depend. We believe that it will be in 
unison with the facts, when we assert that the usual mode of admi- 
nistering an emetic at the present day, is by exhibiting four or five 
grains, in portions of three-fourths of a grain to a grain, at intervals 
of from ten to fifteen minutes, until such time as the act of vomiting 
be induced, aiding and accelerating its operation by copious draughts 
of tepid water, or a weak infusion of chamomile flowers. By the 
solvent powers of the former, and the emetic qualities of the latter, 
every portion of the original emetic substance is ejected from the 
stomach; thus interrupting its cathartic operation, to induce which, 
it is necessary that a portion of the emetic should pass the pyloric 
orifice of the stomach, and be introduced into the alimentary canal. 
Nor is the loss of its cathartic operation the only objection which can 
be urged against this mode of administering emetics. Administered as 
above, their eftects are too, evanescent to derive the advantages which 
ought to result from a more judicious administration of them; the sys- 
tem not being under their eifects longer than from three-fourths of an 
hour to an hour and a half. Even when resorted to for this short 
period, no one has failed to observe their remedial effects; a softer 
pulse, the reestablishment of the cutaneous transpiration, and a more 



TvirnhuW on the Modus Medendi of Emetics. 115 

tranquil condition of the patient, are the usual results of their admi- 
nistration. But, as we observed, when thus administered, the bene- 
ficial effects are evanescent, the speedy withdrawal of the emetic, 
producing these changes, necessarily favours the reestablishment of 
febrile action. We know of no therapeutic principle more allied to 
truth, than that upon which we have always practiced in diseases of 
associated action, viz. that it is by repeated impressions upon the 
circulatory system through the intervention of the g astro -cardiac 
sympathy, that we must hope to break through the chain of morbid 
associations, constituting febrile diseases. 

Gutta cavat lapidem, non vi, sed saepe cadendo. 

It is by a steady perseverance in the use of emetics given in mi- 
nute doses of half a grain at intervals of half an hour, that the system 
will be kept so long under their sedative effects, as most effectually 
to trammel the disease, and thus offer an obstacle to its further pro- 
gress by association. By the use of emetics, the system is brought 
into a condition directly opposite to that of febrile action; and it is 
only by protracting this state of things, viz. by keeping up continued 
but moderate pressure upon the arterial system by the sedative effects 
of an emetic, that we can dissolve tlie chain of morbid actions. An 
attentive observation of the phenomena which develope themselves, 
while the system is under the effect of an emetic, will convince us of 
the necessity of protracting the emetic action. In the exhibition, no 
very sensible effects are produced by the first three or four half grains. 
A well-directed observation would, however, detect certain changes 
which would escape the eye of one not fully skilled in the exhibition 
of emetics. The pulse assumes a softer and more frequent action, 
there is less cerebral excitability, and general corporeal composure; 
nausea now supervenes, and with it universal relaxation, succeeded 
by attempts at vomiting, which accomplished, a universal relaxation 
pervades the cutaneous capillaries, and a corresponding quantity of 
perspirable fluid is the result. This approximation to the healthy 
standard is of short duration; as the effects of the emetic pass off, fe- 
brile action again reestablishes itself, until the lapse of the half hour 
brings with it another half grain, which never fails to produce even 
greater relief, each interval of febrile action being of greater dura- 
tion, until the disease thus checked from time to time, by the obsta- 
cles which it encounters in the sedative action of the emetic, is so 
trammelled in its progress, as eventually to be forced to yield. When 
we contrast this practice with that which now obtains, wq think 
its advantages must be apparent to the most casual observation. In 
protracting the emetic action by the exhibition of minute doses at 



116 Report on Varioloid and Small-Pox. 

proper intervals, we interpose our second dose just at a time when 
all the advantages derived from the emetic substances are about to wear 
off, and febrile action again begins to establish itself; at this critical 
moment we place our veto upon its further progress b j a repetition of 
the dose. In the ordinary mode of administering emetics, all the ad- 
vantages gained by their exhibition are lost by a discontinuance of 
them. Though the disease be partially subdued in the absence of tbe 
emetic, it gains sufficient strength again to become formidable. 
Though a victory is gained, all the advantages which might result 
from a pursuit and total rout of the enemy are slothfully abandoned. 
To some of the profession, the practice of protracting the emetic 
action may be fraught with many and great evils, as tending to in- 
duce an irritable condition of the stomach, not a little to be dreaded. 
Such fears may be calmed by the fact, that when administered in the 
above small doses, we have never known them to have such an effect. 
This will be the more easily credible, when we assert that it is 
never necessary to administer more than from four to six grains 
before the criterion which induces its discontinuance supervenes. 
One or two copious alvine evacuations have always been our signal 
for its discontinuance. Such then are the additional views based upon 
the secondary action of emetics which we proposed to give, and upon 
which has been based a practice singularly successful in diseases of 
associated action. 

Neiv York, .August, 1831. 



Art. X. Report of the Committee of the Board of Health of 
Charleston^ respecting the Prevalence of Varioloid and Small-pox 
in that city during the year 1829. 

X HE Committee of the Board of Health, appointed to report upon 
the prevalence of varioloid and small-pox during the last year, and 
for other purposes, respectfully Report, 

That, to accomplish the duties assigned them satisfactorily, they 
sent the following Circular to the Physicians of Charleston: — 

Charleston^ Nov. 25th, 1830. 
Dear Sir, 

Having been appointed a Committee of the Board of Health, to ascertain 
how far the varioloid and small-pox have prevailed, 8cc. &c. we respectfully, 
(in order to accomplish satisfactorily the intentions of the Board,) present for 



Report on Varioloid and Small'P ox. 117 

your consideration the following interrogations, and earnestly request a reply 
as soon as possible. 

Query 1st. Have you seen any cases of small-pox, and how many during the 
last year? 

2d. Have all the symptoms and stages of small-pox been exhibited in any of 
your patients who have been vaccinated? 

3d. Have you had any cases of. vsi^oloid, and how many? 

4th. How do you distinguish variofoid from small-pox, and how from varicella 
or chicken-pox? 

5th. Have you ever known varioloid to occur among those who had the na- 
tural, or been inoculated with small-pox, or have you ever seen varioloid in 
those persons who have been protected neither by inoculation from small-pox 
or vaccine? 

6th. Have any of your patients with varioloid at any time of your practice, 
(stating the length of time you have practised,) died? 

7ih. Do you regard varioloid as a distinct disease, or as modified small-pox? 

8ih. Has your confidence in the protective power of the vaccine been les- 
sened? , 

9th. Do you think that the careless manner in which persons are vaccinated 
by those who are not physicians, and are incapable of judging, ought to be 
considered a great evil, and a source calculated to lessen confidence in a va- 
luable preventive of small-pox? 

10th. During your experience have you not found it a common custom for 
persons not physicians to vaccinate their domestics and families, to save the ex- 
pense of getting a physician? 

11th. Do you not think that taking so much matter, as is usually the custom, 
from a pustule when there is only one, lessens the chance of a constitutional 
impression being made; and that it would be better to leave one pustule unin- 
jured, to go through all the stages? 

12th. Do you think at any period of life the vaccine would become diminish- 
ed in its power on the system to resist the influence of small-pox? 

13th. How do you distinguish a spurious from a genuine vaccine pustule? 
With due consideration, we are, respectfully, 

THOMAS Y. SIMONS, M. D. Chairman. ") Committee 
J. MOTTE CAMPBELL, M. D. I of 

GEORGE LOGAN, M. D. J Board of Health. 

Your Committee was prevented from giving an earlier report, in 
consequence of the medical gentlemen not having before sent answers 
to the above circular. They, however, now offer the following to the 
consideration of the Board. The Committee will first give a concise 
history of the small-pox epidemic^ and secondly, offer the opinions 
which are entertained in Europe and America upon the value of vac- 
cine as a means of controlling the ravages of small-pox. 

In the performance of this important duty, thej will be as concise 
as possible, avoiding the adoption of any speculative opinions, and 

11* 



118 Report on Varioloid and Small-Pox. 

presenting only such views as seem derivable from actual experience 
and observation. 

In February, 18S0, the small-pox and varioloid first made their 
appearance^ for a year or two previous, scarlatina, measles, and cy- 
nanche maligna, had prevailed, and for several years the small-pox 
had been at the Lazaretto, being imported cases. During the sum- 
mer season, the small-pox and variola seemed to have disappeared, 
but, on the approach of winter, they again made their appearance. 

The small-pox has assumed the various forms of confluent and dis- 
tinct, and has been extremely severe in its type, and frequently fa- 
tal. The number of deaths, according to the records of the Board of 
Health, which does not include Charleston Neck, has been fifty- 
three. 

Sometimes this disease, both in the confluent and distinct form, 
has gone through all the regular stadia with the pustules fully and 
properly developed, which your Committee deem unnecessary to de- 
scribe. In others, however, the eruptions have assumed the appear- 
ance of measlesj have, in the progress to filling and maturation, be- 
come flattened, being imperfectly filled with purulent matter, and, 
in their termination, they have dried up, forming no regular scabs, 
and showing beneath an inflamed, and in some instances a gangrenous 
aspect. In proportion with the imperfect development of the pus- 
tules, have there been great determination to, and inflammation of, 
the mucous tissues of the thorax and alimentary canal, and the tis- 
sues of the brain. This form has generally proved fatal. The vario- 
loid, as it has been termed, was ushered in with great pain in the 
head and spine, accompanied frequently with delirium and gastro-in- 
testinal irritation: on the fourth day an eruption appeared on the cu- 
taneous surface, when the symptoms just described began to subside. 
This eruption has assumed a very irregular appearance — the papular, 
vesicular, and pustular, all in many cases existing at the same time: 
and on the sixth day after their appearance, in place of maturating 
vt^ith fever as in small-pox, they have desiccated, leaving red 
splotches, in a few instances depressions, but more frequently pro- 
minences. There have been some modifications of this — the disease 
partaking partly of the character just described, and partly of small- 
pox. Sometimes successive crops of eruptions have appeared in the 
course of the disease: varicella has likewise prevailed cotemporane- 
ously with small-pox and varioloid, but the fever has been, (previous to 
the eruption,) very mild," short, and irregular in its duration, and af- 
terwards only vesicles have appeared, which were of a few days con- 
tinuance. Your Committee, however, are persuaded that many cases 



Report on Varioloid and SmalUPox, 1 1 9 

of varicella have been confounded with varioloid. Regarding the dis- 
tinct characteristics of these two diseases, there has been great dis- 
crepancy of opinion among medical gentlemen here, as well as in 
other portions of the world. Your Committee will decline, on a sub- 
ject so unsettled in medical opinion, attempting to make any other 
diagnostic of variola, varioloid, or varicella, than the description just 
given, remarking, 

1st. That varioloid is regarded by some physicians as small-pox, 
modified by vaccine and inoculation of small-pox. 

2d. That a few physicians consider it as a distinct disease. 

3d. As secondary small-pox, similar to the diseases which medical 
writers, antecedent to the introduction of vaccine, described as horn- 
pock, nurses-pock, siliquose-pock, sheep-pock, bladder-pock, &c. 

4th. It has been suggested, that only varicella and small-pox have 
prevailed, there being an intimate relation between these two dis- 
eases, and that which has been termed varioloid is varicella, modi- 
fied and increased in virulence by the epidemic influence of small- 
pox, as remittent fevers are aggravated in their type during the pre- 
valence of epidemic stranger's fever. 

From the answers which have been received to the circular, it 
appears that varioloid occurred among the vaccinated, the variolated, 
(or those who have been inoculated with small-pox;) among a few 
who have had small-pox naturally, two of whom have died; and in a 
few instances in those who have been protected neither by natural or 
inoculated small-pox, or vaccination, similar phenomena have been 
noticed in the small-pox epidemics which have appeared elsewhere. 
Your Committee can give no adequate idea of the number of cases of 
small-pox or varioloid which have occurred, not having received an- 
swers from all the practitioners of our city; and of those who did re- 
turn answers, but few kept a register of their cases; the proportion, 
therefore, of those who have died, with those who have been sick, 
cannot be ascertained. Your Committee, however, are satisfied that 
the proportion of deaths from varioloid, in comparison with the num- 
ber that have been sick, has been small. According to the register of 
the Board of Health, there have been but eight deaths from varioloid. 
Some of these may justly be ascribed to the severity of our winter, 
producing violent concomitant catarrhal affections; and some cases 
which have been called varioloid, there is good reason to believe were 
small-pox. 

The second point of consideration which your committee will 
bring to your view, are the opinions which are entertained in Europe 
and America of the value of vaccine as a means of controlling the 



120 Report on Varioloid and Small-Pox, 

ravages of small-pox. And this is the more imperatively called 
for, from the distrust which has been awakened in the efficacy of 
vaccine, since the prevalence of varioloid. It has been already stated 
that varioloid has attacked those who .have been inoculated with 
small-pox, those who have had the small-pox naturally, those who 
have been vaccinated, and those who have been altogether unprotect- 
ed. These facts have been observed, not only in Charleston, but in 
other portions of the United States, and in different countries of Eu- 
rope, where varioloid and small-pox have prevailed. Now it is true 
that the varioloid occurs more frequently among the vaccinated. But 
it must be recollected that by far the greater proportion of individuals 
in Europe and America are protected by vaccine, and hence, by pa- 
. rity of reasoning, where varioloid does prevail, the greater propor- 
tion of cases must be among the vaccinated. It may likewise be 
called to mind that antecedent to vaccination secondary small-pox 
was of frequent occurrence, and has been fully and satisfactorily 
described by the medical writers of those days, under various ap- 
pellations, as nurses-pock, sheep-pock, siliquose-pock, &c. &c. &c. 

With these prefatory remarks, your committee will offer you opi- 
nions derivable from the highest authorities, premising that the me- 
dical periodicals abound with confirmatory testimonials of the opi- 
nions which are now presented. 

In 1805, in consequence of varioloid occurring after vaccination, 
and the distrust which was awakened in many as to its real value, 
the College of Physicians of London were instructed to investigate 
the subject and report. The following extracts from that report are 
offered: — 

"Deeply impressed," says that distinguished body, "with the importance of 
an inquiry which equally involves the lives of individuals, and the pubhc pros- 
perity, they have made every exertion to investigate the subject fully and im- 
partially. In aid of the knowledge and experience of the members of their own 
body, they have applied, separately to each of the licentiates of the college 5 
they have corresponded with the Colleges of Physicians of Dubhn and Edin- 
burgh, with the Colleges of Surgeons of London, Edinburgh, and DubUn; they 
have called upon the societies established for vaccination for an account of their 
practice, to what extent it has been carried on, and what has been the result of 
their experience, and they have, by public notice, invited individuals to contri- 
bute whatever information they had severally collected. They have, in conse- 
quence, been furnished with a mass of evidence, communicated with the greatest 
readiness and candour, which enables them to speak with confidence on all the 
principal points referred to them." 

After referring to the general use of, and confidence in, vaccina- 
tion, the college goes on to state: — 



Report on Varioloid and Small-Pox. 121 

" The security derived from vaccination ag-ainst the small-pox, if not abso- 
lutely perfect, is as nearly so as can perhaps, be expected from any human dis- 
covery,- for ag-ainst several hundred thousand cases with the results of which 
the college have been made acquainted, the number of alleg-ed failures has 
been surprisingly small. So much so as to form no reasonable objection to the 
general adoption of vaccination; for it appears that there are not nearly so 
many failures in a given number of vaccinated persons, as there are deaths in an 
equal number of persons inoculated for the small-pox. Nothing can more 
clearly demonstrate the superiority of vaccination over the inoculation of the 
small-pox, than this consideration; and it is a most important fact, which has 
been confirmed in the course of this inquiry, that in almost every case where 
the small-pox has succeeded vaccination, whether by inoculation or by casual in- 
fection, the disease has varied much from its ordinary course; it has neither 
been the same in violence nor in the duration of its symptoms, but has, with 
very few exceptions, been remarkably mild — as if the small-pox had been de- 
prived, by the previous vaccination, of all its usual malignity.'' 

This strong confirmation of the value of vaccine, emanating from 
a learned body, deriving its sources of information from all the most 
learned medical bodies of Great Britain and Ireland, has been fully 
sustained bj the subsequent experience and observations of physicians 
there, on the Continent of Europe, and in the United States of 
America. As this report is intended not for the information of me- 
dical gentlemen, whose reading upon this important topic it is pre- 
sumed, has made them fully acquainted with medical opinion through- 
out the world, but for the citizens, whose confidence in vaccine has 
been in some degree shaken, your committee must ask indulgence 
when they offer accumulated testimony confirmatory of the opinion 
of the College of Phy^^aitis of London, during the last twenty-five 
years. Dr. Thomson, in an able communication to Sir J. McGre- 
gor, the director-general of the medical department of Great Bri- 
tain, &c. relative to small-pox, varioloid, and varicella, as it prevail- 
ed in Scotland, derivable from his own experience and observation, 
and of some of the most respectable physicians of that country, 
makes the following remarks: — 

**It has been impossible to see the general mildness, of the varioloid epide- 
mic in those who had undergone the process of vaccination, and the severity, 
malignity, and fatality of the same disease in the vaccinated, and not to be con- 
vinced of the great and salutary powers of cow-pock in modifying small-pox, in 
those who were afterwards affected with this disease. Proofs cannot be ima- 
gined more convincing and satisfactory of the incalculable benefits bestowed 
upon mankind by its discoverer, than those I have had the pleasure of witness- 
ing. It has been very agreeable, also, to observe that the terrors at first ex- 
cited by the occurrence of the varioloid epidemic in the families of those who 
had undergone cow-pock inoculation, have gradually given way in the progress 
of the disease; and that the comparison of small-pox in their modified forms has 



122 Report on Varioloid and Small-Pox. 

often forced a conviction of the Advantages of cow-pock inoculation upon the 
minds even of the most ignorant and prejudiced, and induced them to seek 
protection for themselves and their oifspring in a practice which they had for- 
merly neglected or despised." 

A committee of the " Academic Royale," of Paris, make in the 
conclusion of their report, the following remarks: — 

"It is evident that when the utmost concessions are made, when all the 
causes of small-pox after vaccination which have been reported are considered 
authentic, it would be sufficient to compare these rare occurrences with the in- 
numerable cases of the disease in those who have not been vaccinated; and also 
with the immense number of those who have undergone the process, and been 
exposed to contagion with impunity, in order to be convinced that vaccine 
inoculation is one of the most beautiful and useful discoveries that has ever 
been made, and that this invaluable antidote still preserves its virtues." 

In an interesting history of the variolous and varioloid epidemic, 
which prevailed in Philadelphia in 1823 and 1824, by Drs. Mitchell 
and Bell, the following important statement is made, of two hundred 
and forty-eight cases of small-pox and varioloid, which came under 
their notice — one hundred and fifty-five were unprotected, of whom 
eighty-five died; sixty -four vaccinated, of whom one died; nine inocu- 
lated, of whom three died; seven previous small-pox, of whom three 
died; thirteen unknown — no deaths. Now, here is clearly shown 
the ravages which have occurred to the unprotected, there being 
eighty-five deaths, while of the vaccinated only one; of the inoculated 
and previous small-pox, each three, proving that the vaccine made a 
milder form than any other. If there were a greater proportion of 
vaccinated than those who were inoculated, or had previous small- 
pox, who had varioloid, it must be remembered that the propor- 
tion of vaccinated to the proportion of inoculated exposed to varioloid, 
must have been as at least four to one; add to this the danger and 
fatality resulting from inoculation, and the mildness and innocency 
of vaccine, and its value is strikingly illustrated. In the concluding 
observations of a Committee of the Philadelphia Society, appointed to 
report on the variolous and varioloid disease, which prevailed in 
Philadelphia, in 1827, the following language is used. 

** Thus we may, without the least want of candour, come to the conclusion, 
that only one death from small-pox after vaccination had occurred during the 
year 1827, among eighty thousand vaccinaited persons, and during the preva- 
lence of a most malignant and mortal small-pox, while several individuals have 
lost their lives from small-pox after they had already gone once through the 
disease. It appears then clearly that vaccination ought to lose nothing of the 
public confidence, and as a protection from the fatal effects of genuine small- 
pox, it may safely be asserted, it is in every sense to be preferred to inoculation." 



Report on Varioloid and Small-Pox, 12.3 

In this latter opinion, jour Committee most fully concur^ and they 
are authorized to state, that such is the opinion of almost every phy- 
sician in our city. It will now be proper to oifer the opinions which 
have been advanced by Committees appointed by the Medical Society 
of South Carolina, and which were adopted and approved. 

A Committee, in an interesting report upon the epidemic small-pox 
of ISir, as it existed in Charleston, state 

** That their confidence in the efficacy of the vaccine as a preventive of 
small-pox continues undiminished, and they think it the only means by which 
the ravag-es of that disease can be effectually put a stop to. Proofs of its effi- 
cacy are continually presented to our view. They surround us on all sides. 
Did it not destroy the susceptibility to small-pox, every house would become 
an hospital. Scarcely would there be a family but would have to mourn the 
loss of some favourite member by its destructive influence; indeed, what must 
have been the situation of our city for many months past, where so many thou- . 
sands have relied on it exclusively." 

Again, the Committee on the epidemic small-pox of 1824, declare that " vac- 
^cine inoculation, when properly and judiciously performed, still maintains the 
same confidence which has hitherto been reposed in it, as a protection ag-ainst 
small-pox." 

Having, from accumulated testimony, which your Committee col- 
lected from the periodical and other medical works which have been 
published since the introduction of vaccine, (and among which they 
have seen none that does not admit it as the safest and most valuable 
means of checking the ravages of small-pox,) presented to your notice 
evidences from the highest authority of its value; they will consider 
some of the questions which were proposed in the circular, in the 
first part of this report, some of them having been already noticed. 

Ist^ Question Sth. Has your confidence in the protective power of 
the vaccine been lessened.^ It has been answered by all, that although 
vaccine cannot be regarded as protecting from varioloid, it does, 
most generally, from small-pox after vaccination, and not one death; 
and in these few cases the vaccine was supposed to be genuine, only 
from the patient's having been vaccinated by physicians, and not 
from a personal knowledge of the cases, and that it is decidedly the 
most salutary means of checking the ravages of small-pox. 

Q. 9th. Do you think that the careless manner in which persons 
are vaccinated by those who are not physicians, and are incapable of 
judging, ought to be considered a great evil and a source calculated 
to lessen confidence in a valuable preventive of small-pox? 

To this, every physician from whom the Committee have had in- 
formation concurs. They further state, to this cause may justly be 
ascribed a number of the cases of varioloid and small-pox, which 



124 Report on Varioloid and Small-Pox. 

occur after vaccination, ^nd that it has tended materially to impair 
the confidence in vaccine. 

Q. 10th. During your experience, have you not found it a common 
custom for persons, not physicians, to vaccinate their domestics and 
families, to save the expense of getting a physician? It has been 
responded, that few heads of families employ a physician to vaccinate 
their servants, and many even vaccinate their children. 

Q. nth. Do you not think that taking so much matter as is usually 
the custom, from a pustule when there is only one, lessons the chance 
of a constitutional impression being made; and that it would be 
better to leave one pustule uninjured than to go through all the 
stages? 

It is generally believed, that taking too much matter from one pus- 
tule might prevent its full and proper development. That it would 
be better to make two or three incisions on one arm, and when there 
is only one pustule, to take as little as possible from it as a matter 
of prudence — the fact of its injurious tendency being certainly and 
positively ascertained. 

Q. 12th. Do you think at any period of life the vaccine would 
become diminished in its power on the system, to resist the influence 
of small-pox? 

Considerable discrepancy of opinion exists among the physicians of 
Charleston, as well as in other portions of the United States, and in 
Europe, upon this subject. It must, at present, be considered as 
only speculative, sufficient data not having been obtained, by which 
we could in any manner come to a positive conclusion. 

It is generally recommended to re-vaccinate whenever small-pox 
epidemic occurs, as a matter of security; for the second vaccination 
will prove whether the first was efficacious or not. For if the first 
vaccination be efficacious, the second, like varioloid, will run through 
all its stages and desiccate, and not maturate on the sixth day after 
the eruption. 

Q. ISth. How do you distinguish a spurious from a genuine vaccine 
pustule? 

The only answer to this, which the committee can make, is to 
describe what constitutes genuine vaccine, and whatever differs ma- 
terially from this, may be considered as spurious. On the third day 
after the introduction of the vaccine virus, a red cone-shaped pimple 
is observed — from the fourth to the sixth, seventh, and eighth days, 
a transparent, limpid fluid collects, and an areola of inflammation 
appears around the pustule. From the eighth to the fourteenth the 
fluid becomes turbid and of a purulent nature — the scab forms in the 



Report on Varioloid and Small-Pox. 125 

centre of the pustule — the circular inflammation is increased and ac- 
companied with fever. From the fourth to the sixteenth, eighteenth, 
and twentieth days, the scab is completely formed and drops off, 
leaving a scar having many depressions of a cellular appearance. 

It must be remarked, that the stadia in the development of a vac- 
cine pustule are lengthened or diminished in some degree by tempe- 
rature, being lengthened by cold and lessened by heat. The vaccine 
virus should be used when it is perfectly limpid and transparent. 

Such are the testimonials which your committee have been enabled 
to bring to your view. They have not given the individual opinions 
of the medical gentlemen who politely sent answers to the circular, 
as they would occupy too much space; but they believe they have 
fairly represented their opinions. 

It will thus be seen, from the according testimony of the most 
scientific and observing physicians in Europe and America, that vac- 
cine has been regarded as one of the greatest blessings conferred upon 
the human race. 

If we look for perfection in any thing, we will be grievously mis- 
taken; but it would be unwise and unphilosophical, because a disco- 
very could not accomplish all that we could wish, that it should be 
discarded. 

The correct method of ascertaining the value of any discovery, 
is to compare it with others, and if worse, to reject, if better, to 
adopt. Now your committee maintain, that the evidences which have 
been brought to your view, prove beyond all matter of controversy, 
that the introduction of vaccine, although it has not extirpated small- 
pox, has disarmed it of most of its terrors. Let us observe how many 
human beings throughout the world are protected alone by vaccine from 
small-pox, and it becomes a matter of wonder that so many escape that 
Protean disorder, and of those who do not escape, how few suffer, when 
it is proved in the unprotected to be most virulent in its form, and most 
fatal in its consequences. But when we come to consider the many 
abuses to which vaccination has been exposed, from the number of 
individuals who have vaccinated, v/ho are incapable of judging what 
is genuine vaccine, and from the carelessness oftentimes of physi- 
cians in not accurately observing its different developments, our con- 
fidence in its salutary influence becomes greatly increased. 

Before concluding, your committee, by way of recapitulation, 
would remark — 

1st. That since the introduction of vaccine, small-pox has been 
much less frequent, and the number of deaths from it greatly dimi- 
nished. , 

No. XVII. —Nov. 1831. 12 



126 Report on Varioloid and ^mall-Pox. 

2d. That the inoculated with small-pox, and the vaccinated, have 
the varioloid with equal virulence, and if the number of vacci' 
nated who have the varioloid be greater, it may be justly ascribed to 
the fact, that the greater proportion of individuals are protected by 
vaccine. Furthermore, varioloid sometimes occurs among those who 
have had the natural small-pox, as well as those who are altogether 
unprotected. 

3d. That previous to the introduction of vaccination or inoculation 
with small-pox, secondary small-pox occurred, and presenting forms 
different from the genuine small-pox, but partaking of its character. 

4th. That in a great number of cases where small-pox has occur- 
red after vaccination, and even varioloid, it has arisen from the vac- 
cine virus being spurious. 

5th. That great carelessness has been exhibited in vaccination, it 
being regarded as a simple operation, and has, therefore, been per- 
formed by those who are incapable of deciding whether the vaccine 
virus has gone through its regular stages. 

6th. That although vaccine does not exempt all persons from what 
is termed varioloid, it does the greater proportion, and must be con- 
sidered as the most efficient and safe plan of checking the ravages of 
small-pox, and therefore should be continually practised. Finally, 
it may be proper to remark that vaccination, in place of diminishing 
in public confidence from time and experience, is increasing. It is 
becoming general, not only in Europe and America, and the colonies, 
but in India; and the present Turkish sultan has had his children 
vaccinated, as an example to, and a means of introducing it among, 
his people. In several kingdoms of Europe, vaccination is conduct- 
ed under the auspices of government. In the United States it is ge- 
nerally recommended, and in a few large cities vaccine institutions 
have been instituted, but it is much to be deplored that a means so 
simple, and yet so signal in its beneficial effects, should still be so 
neglected. To show how efficient vaccine is when properly conduct- 
ed, the following out of many other evidences are presented to your 
view. 

Dr. LuDERs remarks, that of two hundred and twenty -three thousand 
nine hundred and thirty -nine vaccinated, between 1801 and 1822, 
in Holstein, where the measures of the government ensure a perfect 
vaccination, there had occurred, down to 1824, only two cases of 
small-pox, and that in Denmark, among four hundred and forty-seven 
thousand six hundred and five vaccinated, only one such case has 
been met with. 

Again, in the Orphan Institution of Charleston, having one hundred 



Report on Varioloid and Small-Fox. 127 

and fifty souls, all of whom, except the officers and servants, are 
children. Dr. Logan, the physician to that institution, remarks, 
*'Not a single case of small-pox or varioloid has occurred. All of 
the children are vaccinated by him, and if they have been previously 
subjected to that process, are re-vaccinated, to test the efficiency of the 
previous vaccination^ and these children have been allowed to have 
communication with the citizens generally." 

In conclusion, your committee would strenuously urge the pro- 
priety of vaccine institutions being established in the principal cities 
in our state, and would strongly recommend the citizens never to ne- 
glect having all under their care vaccinated. It is with pleasure they 
state that the city council have made an honourable and worthy ad- 
vance in this important measure, and it is earnestly to be desired that 
what they have begun maybe more generally and extensively adopted. 
Respectfully submitted, 
THOMAS Y. SIMONS, M. D., Chairman.-) 
J. MOTTE CAMPBELL, M. D. I Committee. 

GEORGE LOGAN, M. D. J 



( 128 ) 



REVIEW. 

Art. XI. Observations on the Structure and Diseases of the Testis. 
By Sir Astley Cooper, Eart. F. R. S., &c. pp. £45, large quarto, 
with plates. London, 1830. 

IN undertaking a short analysis of this work for the information of 
our readers, it affords the greatest pleasure to express a conviction of 
its value, and of the many important professional precepts which it 
contains. The entire style in which it is got up, reflects much cre- 
dit on the British press, and is evidently the result of much labour 
on the part of its distinguished author. The typographical part is 
finely executed, and the anatomical and pathological features ele- 
gantly illustrated by plates, each of which contains a number of 
figures representing natural colours. Sir Astley Cooper's name is 
so favourably known in the United States, that it requires no prepa- 
ration of the public mind to receive indulgently his professional con- 
tributions. In addition to the intrinsic merit of the work under review, 
we cannot be less than much pleased in seeing one so abundantly rich 
as he is in professional honours, and in the means of personal com- 
fort, still manifesting a zealous loyalty to his profession, and in the 
midst of every temptation to indulgence and relaxation, augmenting 
his well-earned fame, through the arduous course of dissections and 
clinical observations, and closing his professional life by bestowing 
such excellent legacies on his successors. In this he executes what 
all old practitioners recommend, but unfortunately too few perform. 

The subjects treated of are the anatomy of the testis — its acute 
inflammation — simple chronic diseases — irritable testis — its inflam- 
mation from mumps — hydatids — scrofulous inflammation — venereal 
inflammation — ossific inflammation — scirrhous and fungoid diseases — 
castration — hydrocele — inflammation of the tunica vaginalis — cartila- 
ginous bodies in the tunica vaginalis — fungoid inflammation in the same 
— haematocele — varicocele and chimney-sweeper's cancer. From the 
preceding list it will be seen that its range is extensive, and at least 
includes all the diseases of the testis that the practitioner is common- 
ly called upon to manage. 

Anatomy of the Testis, — This part of the subject has been treated 
in considerable detail, and the observations are, in general, confirma- 
tory of the views of the best authorities. His injections and dissec- 



Cooper on the Structure and Diseases of the Testis. 129 

tions seem to have been from the representation of them remarkably 
successful. There are, however, some peculiarities in his opinions. 
The average measurement of the testis he gives as two inches, by 
one and a half. This is certainly beyond the standard of the United 
States. The notion of a dartos muscle is repudiated in toto; in this 
opinion, however, we think the learned author rather too exclusive — 
for though in by far the majority of subjects its vestiges are extinct, 
yet occasionally the muscular character is very distinct, particularly 
when the colour has been evolved by the use of nitre. We also think 
contrary to his assertion, that the natural motions of the scrotum are 
in favour of this muscularity. Sir Astley considers the tunica albu- 
ginea to consist of two laminae, the outer one resembling in its fibrous 
character the sclerotic coat of the eye — and the inner layer, which 
he calls the tunica vasculosa, and which he asserts to be highly vas- 
cular, and carrying its prolongations through the substance of the 
testis, to furnish pouches which conduct the blood-vessels, and enve- 
lope the tubuli seminiferi. This is an improved modification of the 
ordinary description of the septulse testis. The corpus highmorianum, 
which exists at the back of the testis. Sir Astley, without referring to 
the established name, or indeed seeming to consider the knowledge 
of the part as common place, proposes, we think with very equivocal 
utility, to call the mediastinum testis. We have no objection to the 
term itself, but as the former is sanctioned by long and general usage, 
the introduction in its place of a new one, is detrimental, by a multi- 
plication of terms, in a science already profuse in them. This effort, 
by the way, is not the only one in his book, and as the objection is 
equally applicable in other instances, we would here, as the advocate 
of anatomy, enter our general protest against it. There is no indi- 
vidual now alive, whose reputation can effect such substitution with 
the body of experienced anatomists, and a partial reform merely 
serves to make the inexperienced, misunderstand. 

It will be unnecessary to trace the author through the description 
of the several parts of the testis, and its auxiliary structure^ the 
whole is executed, as stated, much in detail, and in a very elaborate 
though satisfactory manner. The author coincides with Mr. Julius 
Cloquet, on the anatomy of the cremaster muscle, (p. 42,) but does 
not refer to this very eminent anatomist as the origin of his informa- 
tion, in which we think he has made rather an exceptionable omission, 
considering that the observations of Mr. Cloquet on this subject are 
comparatively recent. We would indeed remark further, that as 
much of this work is devoted to pure anatomical descriptions of the 
testis, it as a scientific production, is singularly and rather lamenta- 

12* 



130 Cooper on the Structure and Diseases of the Testis. 

bly destitute of reference, to what has been done bj other able men, 
on precisely the same subject. Though elaborate, it is written with 
as much naivete as if its excellent author were nearly all the time 
upon ground heretofore unexplored, either by his own countrymen or 
others. We do not think that the actual degree of novelty in it, com- 
pensates fully, for the omission of ordinary scientific acknowledg- 
ments. A strong personal regard for the author, inclines us to touch 
with lenity its defects; and yet this is one which perhaps the para- 
mount interests of anatomy justify us in pointing out. We have indeed 
been frequently struck with the insular character of medical works 
emanating from the London press, and would scarcely suppose from 
the poverty of reference in them to the scientific labours of foreigners, 
that they radiate from a point of the globe, connected with other 
countries by almost innumerable channels of trade. Sir Astley is 
known to cultivate the most hospitable and liberal intercourse with 
foreign professional men; we therefore feel mortified in seeing this 
quarantine of other good works established in his own, especially 
when the latter might have been improved, by relaxing it somewhat. 
Living as we Americans do, at a great distance, and under circum- 
stances unfavourable to national partialities or prejudices, we view 
tranquilly the scientific labours of all countries; we have no objection 
to receive such information as is useful, and as little hesitation in re- 
jecting such as is trivial, and brought forward by the influence of 
high names or strong state connexions. Should these lines ever meet 
the eye of the distinguished author, we are assured that they will 
communicate nothing new to him in quoting, as also well worthy of 
study, the excellent plates and descriptions of Albinus, Haller, 
LoDER, RuYscH, MuNRo, HuNTER, &c. &.C. on the samc topic, none 
of which are referred to by him. 

The acknowledged difficulty of injecting the tubuli seminiferi will 
make the following hint valuable. 

" Having- traced the canals of the rete (testis) and found that they were 
situated in and completely inclosed in the tunica albug-inea, it struck me that I 
might inject these tubes with glue, or even coarse injection, by passing a fine 
silver or steel pipe into the canals of the rete; and having made trial of this 
plan, I have injected the tubuli seminiferi with coloured fine injection, and the 
vasa efferentia were also readily filled, and have been thus able to make some 
beautiful preparations, more easily dissected and much less easily spoiled, than 
those which are made by injecting the tubes with quicksilver. The rete can 
even be filled with coarse injection, and the beginnings of the tubuli and of the 
vasa efferentia will receive the injection. If the injecting pipe be placed in the 
backof the mediastinum, the injection readily escapes into the absorbent ves- 
sels, and those of the spermatic cord becTome filled." 



Cooper on the Structure and Diseases of the Testis. 131 

Diseases. — The following observations exhibit a qualified and ra- 
tional view of certain doctrines which were once very prevalent, and 
will perhaps indicate the general tenor of the author's mind on those 
points:— 

"Hernia humoralls has been the term usually employed by surgeons, to ex- 
press the inflammatory sta.te of this organ (the testis;) but it is an appellation 
obviously founded in false physiological views, and upon mistaken pathological 
principles. The humoral pathology has vanished under better defined, and 
more correct pathological opinions; and diseases are at present attributed more 
to the altered actions of the solids, than to a change in the nature of the fluids. 
Yet perhaps the moderns have gone into a contrary extreme, and have too much 
lost sight of the fluids in the morbid changes of the body. For it is clear that 
the secreted fluids are often so changed in their nature, as to be capable of pro- 
ducing disease, and even of becoming poisonous — as the mucus of the urethra, 
in gonorrhoea — the matter of a chancre — the secretion of a small-pox pustule — 
and the fluid of a vaccine vesicle. My friend Mr. Colman has also found, that 
if the blood of a horse affected with glanders, be injected into the veins of an- 
other and healthy horse, it will produce the glanders in that animal; and thus 
he proves, by direct experiment, that the fluids are aflTected in that disease, as 
well as the solids; for its blood, the mucus of the membrane of the nose, the 
sinuses of the bones of the head and face, and even the lungs themselves, are 
brought into a diseased state. But still the term hernia humoralis is most im- 
properly apphed to inflammation of the testis; for although the disease be the 
consequence of gonorrhoea, it has nothing gonorrheal in its character, or vene- 
real in its nature, and if I were not fearful of being thought affected, I should 
give it the name of testitis." - 

These views will probably receive the sanction of most practical 
pathologists of the present day, and we would merely remark, that 
the author's difficulty of a good name, has already been overcome for 
some years past, by the adoption of that of didymitis by very excel- 
lent authority?* upon admitted principles of the modern and im- 
proved nomenclature of diseases. 

Sir Astley recommends for this affection an active antiphlogistic 
treatment, with suspension ofthe part, and a recumbent position, in fact, 
the mode of management commonly adopted. Should circumstances 
render the application of leeches inconvenient, he considers that a 
good substitute may be found in puncturing, transversely, three or 
four veins ofthe scrotum with the point of a lancet, the patient being 
upright. They will bleed freely, especially if the scrotum be placed 
in warm water, and upon the patient lying down the bleeding will 
cease. 

Should the depleting practice not succeed, from a peculiar irrita- 

* Roche and Sansom. 



132 Cooper on the Structure and Diseases of the Testis, 

bility of the patient's system, our author recommends submuriate of 
mercury, with Dover's powders^ but he specifies neither the dose nor 
the duration of such treatment. He considers that immediately upon 
the formation of matter by suppuration, a free opening should be 
made into its focus, to prevent the destruction of the tubuli semini- 
feri. 

For the chronic induration and enlargement of the testis, conse- 
quent to its acute inflammation. Sir A. recommends various ointments, 
the basis of which is either mercury or iodine — ^he speaks highly of 
an oiled silk bag; also of the internal mercurial treatment, &c. From 
the variety of his prescriptions, we are inclined to think that he, like 
the rest of us, has found this rather an untractable aftection. 

The chapter on irritable testis is highly interesting; the aftection 
is principally known by an undue and permanent sensibility of the 
part, attended with but little tumefaction. All motion and even 
handling is attended with an increase of pain. Sir A. says that it 
sometimes endures for years, and that he has found it occasionally so 
untractable, attended with so much distress, and producing sucli 
complete inaptitude for business or pleasure, that he has been thrice 
compelled to acquiesce in the wishes of patients to obtain relief from 
an operation. The author does not consider this disease to be in- 
flammatory, but rather of the nature of tic douloureux. On dissecting 
the testicles which he removed for it, he found no apparent change of 
structure in any of them. His treatment is tonic, narcotic, mercurial, 
and revulsive, but not depletory. 

On hydatid disease, Sir Astley remarks, that there is so strong a 
resemblance between it and hydrocele, that it is occasionally misun- 
derstood by the most experienced practitioners of the metropolis. 

" I know there are persons who never confess an error, but give all their 
successful cases to the world, carefully concealing those that are unfortunate, 
and thus lead young men to believe that our profession is much more successful 
than it really is; but this is a most unfair procedure, for it is only by a compari- 
son of success and misfortune that a fair and honest conclusion can be drawn. 
A surgeon once said to me, * you are foolish in mentioning your unsuccessful 
cases, which the world will discover soon enough.' To which I might have 
replied, * you are dishonest in relating those only which are successful, as you 
thus give an improper colouring to your profession.' 

" For myself, I confess that I have been two or three times mistaken, and 
put a lancet into the part, expecting to find water issuei, and a few drops of 
blood only have followed. But further I will observe, that I have no shame in 
confessing this, nor have I seen mischief arising from it; but on the contrary, in 
doubtful cases, I recommend that a small incision be made into the tunica vagi- 
nalis, to ascertain if it contain a fluid or not. In doing this, no injury can happen to 



Cooper on the Structure and Diseases of the Testis. 133 

the testis, and the surg-eon's mind Is completely at rest respecting the existence 
of hydrocele." 

In addition to this test, Sir Astley considers that the following 
diagnostics should be attended to in hydatid disease: — A yielding 
rather than a fluctuation — a heavier swelling — the general form of the 
testis being preserved, although it is somewhat more pyriform — the 
entire absence of transparency— the sensation of the testis being 
squeezed, if the compression be considerable — the dilated state of the 
vessels of the cord and scrotum — and the testis in hydrocele being 
felt at the lower and back part of the swelling. 

Our personal experience is in favour of the difficulty of distinguish- 
ing between hydrocele and hydatid disease, and we have seen one 
case where the affection was not cleared up until a trocar was intro- 
duced in fact for a hydrocele, and the water drawn off. 

Sir Astley considers all other treatment but extirpation as useless 
in this disease, and his experience teaches that to be completely suc- 
cessful. We are sorry that we cannot join him in this experience^ 
in two cases which have come under our view, and where the testicle 
was the size of a large ostrich egg; it was found to be attended with 
great enlargement and fungoid degenerescence of the lumbar lym- 
phatic glands. In the one case the patient died shortly after the 
operation, and in the other at a more remote period. The plate on 
this disease is admirably executed. 

The scrofulous inflammation of the testis, is considered by the au- 
thor to be merely the result of that vitiation of our tissues which oc- 
curs in the scrofulous diathesis; he has given the several indications 
of this which we have no occasion to repeat. He considers the most 
of the secretory glands as exempt from this degenerescence excepting 
the testicle, which is subject to it from puberty till manhood, and oc- 
casionally even in infancy. This affection is marked by swelling, 
without pain, and having a very slow increase; the scrotum is undis- 
coloured, and its veins are not enlarged. After a while suppuration 
follows, and most frequently in the epididymis. If the affection be 
not cured, the testis wastes away, until only a very small portion is 
left. 

As Sir Astley views this as a disease of debility, he accordingly 
recommends air, sea-bathing, tonics, alteratives and iodine; to cure 
the sinuses which are left he uses stimulating injections. 

Venereal inflammation of the testis, which may be doubted by 
some, our author speaks of as having frequently presented itself to 
him, along with the secondary symptoms of syphilis. His remedy 
for it, is a course of mercury. 



134 Cooper on the Structure and Diseases of the Testis. 

His observations on fungoid disease present the characters of this 
affection in extenso, and in a very interesting light. When once 
formed he considers the complaint as hopeless, for it runs on to a 
fatal termination in spite of internal remedies, castration, or any thing 
else which has been heretofore devised. He, notwithstanding, re- 
commends the removal of the testicle within three months of the be- 
ginning of the disease, and the use of alterative medicines to prevent 
the return of the latter. It is scarcely necessary to state that this 
alterative plan consists in the administration of the preparations of 
mercury. As the cases quoted in illustration were all fatal, we have 
yet to learn whether the treatment will succeed. 

On the subject of varicocele. Sir Astley recommends the palliative 
treatment in common use, as a suspensory bandage, refrigerant lo- 
tions, and avoiding tight clothing about the abdomen. He puts no 
confidence in tying up the spermatic veins, and makes the following 
remarks thereon. 

" It is an operation which I should dread most exceedingly, as placing" the 
life in great hazard, and which I would not therefore recommend: for opera- 
tions upon veins, from the great irritability of those vessels, are more dangerous 
than those on arteries, extended inflammation sometimes following, sometimes 
even to the heart itself; and often a suppurative inflammation on their inner 
coats, which I have several times seen destroy life in operations on the veins of 
the extremities." 

In taking our leave of this production, we feel it a duty to express 
again our sentiments of its value, and to recommend it to the atten- 
tention of the medical public. W. E. H. 



( 135 ) 



BIBLIOGRAPHICAL NOTICES. 

XII. History of Chronic PhlegmasiaB^ or Inflammations i founded on Clinical 
Experience and Pathological Anatomy^ exhibiting a view of the different va- 
rieties and complications of these Diseases, with their various Methods of Treat' 
ment> By F. J. V. Broussais, M. D. Knight of the Royal Order of the Le- 
gion of Honour, Physician-in-Chief and First Professor in the Mihtary Hos- 
pital of Instruction of Paris, Member of the Royal Academy of Medicine, of 
the Royal Medical Society of Madrid, of the Patriotic Society of Cordova, 
Corresponding" Member of the Society of Emulation of Liege, of the Medical 
Societies of Philadelphia, New Orleans, and Louvain, &c. &c. Translated 
from the French of the Fourth Edition, by Isaac Hats, M. D. and R. Egles- 
FELD Griffith, M. D. Members of the American Philosophical Society, of 
the Academy of Natural Sciences, Honorary Members of the Philadelphia 
Medical Society, &c. &c. Philadelphia, Carey & Lea. 8vo. Vol. I. pp. 
497; Vol. II. pp. 404. 

We hav^ long desired to see an English version of this chef-d'oeuvre of the 
founder of physiological medicine. Standing as it does, as the parent stock 
whence have issued the two rival schools of modern medicine, its mode of in- 
vestigating diseases, as well as the facts which it contains, should be familiar to 
all who take an interest in following up medical science in its present rapidly 
improving condition. For where shall we find, among the numerous works 
which have appeared in France since the first edition of the History of Chronic 
Phlegmasise, in 1808, one that has surpassed this their great prototype; or even 
•connected in so clear and philosophical a manner the morbid alterations of 
structure disclosed after death, with the antecedent operation of morbid causes 
and the modifying effects of remedial agents, so as to deduce from the whole 
a body of doctrine in the true spirit of the inductive system, as is every where 
exhibited in the work before us? Let us go one step further. The physiolo- 
gical doctrines, based, as all must admit, on a knowledge of the healthy and 
morbid structures of the system, and the influence which external and internal 
stimuli exert on the various condition of these structures, are in truth intimately 
connected with the progress of pathological anatomy, and must eventually 
give to such researches what they shall actually possess of practical value; how- 
ever the anatomical pathologist of the present time may disclaim the connec- 
tion, and pretend to build up a system of science on anatomical characters 
wholly devoid of theoretical deductions. Although many of the works of this 
class have largely partaken of this spirit, they all exhibit, in a greater or less 
degree, the influences of prejudice and early preconceptions. Let us recal, in 
a cursory way, the characteristic features of some of the most eminent, and exa- 
mine how far they have advanced the science in deviating from their great 
model. 

The immortal work of Laennec's, it must be confessed has greatly advanced 
our knowledge of the diagnosis of diseases of the chest, still the spirit of his 



136 Bibliographical Notices* 

investigations tends, in our opinion, to give a vicious direction to the study of 
patholog-y, by viewing" too exclusively the organic lesions as constituting the 
essence of the disease, without duly appreciating the various agents that have 
modified these alterations in their progress, from their incipient condition to 
their fatal termination. Such a mode of investigation is very far from justly 
estimating the effects of irritation, with their attendant consequences, as first 
pointed out in the work before us, and still more fully developed in Broussais' 
later productions. Even Andral's Clinique, containing an immense collection 
of valuable facts, every where exhibiting persevering research, sagacity of ob- 
servation, and untiring minuteness of detail in tracing out and displaying the 
morbid alterations induced, is yet extremely defective as a doctrinal exposition 
of the science, "VVe rise from the perusal of its numerous cases, conscious of 
having travelled over an immense field, rich with the fruits of actual observa- 
tion, but unable to apply its stores to the dally occurrences of practice. The 
author has endeavoured to execute the work in the exclusive or pure spirit of 
empirical observation, without allowing himself to be swayed by the opinions 
or principles of any system or doctrine whatever, either in drawing up the in- 
dividual cases or in afterwards grouping the whole in conformity with any such 
previous views; and we are free to acknowledge that he has executed this de- 
termination with entire success. Consequently, his facts and observations stand 
out, separated and detached, in a great measure, from each other, bearing no 
constant and close relations with the vital laws of the economy, and indeed as 
a whole are insusceptible of being formed into a system of principles for future 
guidance in the observation and treatment of diseases. Volumes of such works 
would doubtless greatly add to our already accumulated mass of valuable but 
sterile facts, without, however, contributing in any material degree to the ad- 
vancement of scientific, or what we esteem synonymous, systematic medicine, 
by extending our knowledge of the laws which regulate the vital operations in 
health and disease. 

If such be the errors of two of the most eminent and successful of the anato- 
mico-pathological school, how much more is there to object to most of the 
others. Cruveilhier, who perhaps deserves to be placed in the first rank of 
this class of physicians, is more exclusively a pure pathological anatomist than 
Laennec himself, and can hardly be considered, in the ordinary acceptation of 
the term, a cultivator of pathology. His second performance, the Medecine 
Pratique, however, exhibits less of this fault, and deserves to be placed among 
the valuable contributions of modern pathology; whilst the splendid work now 
in progress displays rather the talents of an able anaiomist than the reasonings 
of a profound pathologist. 

Lallemand's most excellent treatise, a work unrivalled on the pathology of 
the brain, although It was drawn up for the most part from the cases and prac- 
tice of others, whilst the author was as yet a student of medicine, is too evidently 
the result of his adoption of the physiological doctrines as inculcated in the 
Chronic Fhkgmasiso, Examination, and other productions of that school, to 
allow us to class him with the anatomical pathologists. Yet he himself seems 
unwilling to merge his professional character under the overshadowing influ- 
ence of the great reformer, and would be considered as advocating no particu- 
lar system of doctrines. Such feelings may be praiseworthy in themselves. 



History of Chronic Phlegmasise. 137 

calculated to advance the g-eneral Interests of science, and we do not complain 
of them, but while we accord unqualified praise to the work, as one of the 
most valuable contributions of the age, we must not be unmindful of the ge- 
nius that presided over its execution, and has substantially given to it that 
which has placed it in the very first rank of contemporary productions. 

Passing by Batle, Sekbes, Olivier, Bertix, with many other authors of 
excellent monographs, as well as the whole host of writers acknowledging them- 
selves to be the adherents and favourers of Broussais' system of doctrines, we 
will barely mention GEisrDRiisr, Billard, RosTAi<r, TACHEROif, Breschet, Geor- 
GET, LoBSTEiJf, and Bretoniteau as furnishing valuable additions to our stock 
of pathological knowledge under the best influences of the principles of the 
physiological medicine, without at the same time avowing themselves the ad- 
vocates of its peculiar tenets. 

In this long list of the authors of the anatomico-pathological school, we have 
omitted the name of Lottis, because we have nothing to object to him on the 
score of his mode of investigating disease, and moreover his labours are suffi- 
ciently distinct to deserve to be considered apart from the sect which claims 
him as a collaborator. Louis is, if possible, less of a theorist than Andral in his 
Clinique, for there is no want of that quality in his Precis, yet the rare talent 
of discrimination with which the diiferent morbid derangements are analyzed, 
referred to their respective origin, and the collective cases of each disease 
grouped by their analogous symptoms, all naturally tend to give to his researches 
a systematic form, and a practical usefulness which we may in vain seek for in 
the writings of Andral, or indeed of any of the disciples of this school. After 
the work now under notice, we know of no modern French production so worthy 
of being translated into our tongue as the Recherches Anaiomico-pathologiques of 
Louis, and his work on typhus and other malignant fevers. They seem to us 
calculated to be of more immediate service than any of the productions of the 
physiological school. They certainly possess this advantage over any of the 
writings of that obnoxious sect — they have not been judged and condemned 
unheard, and all classes, both practitioner and student, would willingly draw 
from their abundant treasures many excellent practical lessons, without the ap- 
prehension of being contaminated at the same time by medical heresies. 

In thus passing in rapid review some of the many works that have felt the 
happy influences of the History of the Chronic Phlegmasiae, let it not be 
thought that we have lost sight of the work under consideration. We deem 
its eff'ects in that respect to have been highly important, and that its example 
will be still felt in the further progress and improvement of the science. Be- 
sides, it cannot be expected that we should at this late day make a critical exa- 
mination of its principles and peculiar doctrines. The high encomiums that 
were passed on the work on its first appearance, in 1808, have never been 
called in question, even by the staunchest opponents of the physiological me- 
dicine, although all the other productions of the author have given rise to a 
violence and acrimony of controversy that is unexampled in the annals of the 
profession. We refer, therefore, the reader to its pages for what he will find 
well worthy of his study and meditation, with simply remarking, that it was in 
this work Broussais first called the attention of the profession to the great and 
important truth, that there was a numerous class of obscure diseases with ano- 
No.XVII.— Nov. 1831. 13 



1 38 Bibliographical Notices. 

malous symptoms, which were considered to arise from debility and languor of 
the system, or some vice or vitiation of the habit, and for which stimulants, 
under the designation of tonics, antispasmodics, resolvents, deobstruents, &c. 
according" to the particular theory held and the supposed nature of the case, 
were universally lavished, to the inevitable injury of the constitution and the 
frequent fatal termination of the disease. That, on the contrary, all these cases 
arose from and depended upon an inflammatory irritation of an obscure and 
chronic character of the digestive or respiratory organs, and that they rt^quired 
for their removal the avoidance of all irritating agents, and the employment of 
depletion, antiphlogistics, emollients, diluents, or appropriate revellants, ac- 
cording to the seat and force of the ailment, and other attendant circumstances. 
When we consider the benefits that have arisen from the propagation of such 
views in the treatment of dyspeptic cases alone, we shall not hesitate to place 
Broussais among the great benefactors of the age, although he had never given 
ilb the world the physiological medicine. The prodigal use of stimulants in 
these cases had been so ancient, universal, and deep-rooted, that it required, 
in order to meet the question properly, to inquire into and scrutinize the cause 
of these derangement^j^he modifying operation of agents on their progress, and 
to ascertain the Tisii^l? -of the lesions left after death. All this Broussais^iias 
done in an able manner, and so far definitely established his principles that no 
one has endeavoured to refute them by resorting to the same inductive method. 
The doctrine of the inflammatory origin of tubercles, wherever seated, has en- 
countered more opposition; still, whoever shall dispassionately examine the 
facts and arguments on which this opinion is founded, must admit that inflam- 
mation has much more to do with their production and ulterior changes than 
either Bayle or Laennec are willing to allow. Moreover, the doctrine of their 
inflammatory origin is calculated to lead us to place confidence in such hygienic 
and remedial measures as experience has proved to be of most avail, where our 
resources at best have heretofore done so little. 

We here close our brief remarks, satisfied, if we should be successful in giv- 
ing our readers as high an opinion of the work as we ourselves entertain of it, 
we would thereby render a better service than if we had endeavoured to com- 
press its prominent doctrines within the limits of a review. C. D. 

New Yurky September, 1831. 



XIII. Descriptio Ichthyosis Cornese Congenitae in Virgine observatse, tdbulis tribus 
lapidi incisis illustrata. Bremse. Chk. Helv. Schmidt, M. D. 

Description of a Case of Congenital Ichthyosis Corneae, observed in a Young Girl,- 
with three Lithographic Plates. By Chk. Helv. Schmidt, M. D. Folio, pp. 
15. Bremen, 1830. 

Frances Kroone, the subject of this case, was born in the town of Diis- 
tedt, in Holland, a short distance from the Rhine. When seen by Dr. Schmidt, 
she was twenty-two years of age; her face was perfectly free from every or- 
ganic defect, and quite comely; her complexion was fair; her skin soft and 
thin; her eyebrows and eyelashes yellow, dense, and well-formed; her teeth 
sound and handsome. 

The disease first made its appearance at the origin of the sterno-cleido-mas- 



Case of Congenital Ichthyosis. 139 

toid muscles, under the form of scurf. The upper portions of the breast and 
neck not so well covered by the dress, were unaffected by the disease, which 
was likewise the case in the axillae, where there was a' scanty covering" of hair? 
but on the areolae of each mamma were to be seen very dense excrescences, 
arranged in concentric order, and from the inferior part of the breasts the 
ichthyosis, which was of the simple species, however, at first, covered the whole 
body, save a place which was but partially affected at the umbilicus, and a 
few spots upon the back. Numerous small, very dense scales, one or two lines 
in height, and seated in the skin, covered the whole abdomen, back, nates, 
feet, and arms, as well as the palms and soles? and the head itself was not en- 
tirely free* 

On each of the extremities were to be seen firm, horny corpuscules, mingled 
■with some hairs, three or four lines, or even more, in height: one was two or 
more lines broad, and to appearance squared by rule, some were round, and 
others again in the form of an inverted cone: the stems of the latter were con- 
nate in patches of three or four, and impaired in various places the appearance 
of the checquer work. Between the digital members of the hands and feet, 
and at their extremities, these horny crusts were broader? partly from the com- 
pressions they experienced, and partly from a thicker concretion, on account of 
the greater sudorific discharge of these parts. 

The configurations covering the palms of the hands were extended to the 
arms, where Ihey were even more numerous and ttiick, though the lineaments 
of the arras could still be traced. But the feet and legs were so surprisingly 
deformed as ito render an accurate description very difficult. Upon the ex- 
tremities of all the phalanges, the disease was likewise to be seen, through 
which the fjedness of the subjacent parts appeared. But the feet and especi- 
ally the right one, were completely sheathed, and the scales were very large 
and thick on the sole of the foot; some nearly an inch long, and as much ele- 
vated? some <if the colour and texture of horn, and others of an ivory appear- 
ance: there was likewise a great variety in their form. 

But the disease did not only invade the epidermis, it attacked the nails of the 
•fingers and toes, which were subjected to similar changes. Those of the fingers 
were thick, short, rigid, and cloven; the lamina of which they were composed 
were distinctly seen; their lunula of the nails was effaced. Their colour was 
of a pale yellow, nearly resembling burnt horn; the extremities of the pha- 
langes were pointed. The nails of the toes were thicker than those of the 
fingers and narrower than usual, composed as it were of horny tubercles, curv- 
ed upwards, and of irregular form, since as the inferior stratum of the nail was 
unimpaired, they had elevated a part of the superior surface of the plate. 

The head itself was not free from this covering. The whole anterior part 
of the scalp was covered with large sessile scales, which, just at the mar- 
gin of the forehead, were separated by a narrow tract of mingled yellow, 
white, gray, and black hairs, chiefly diseased, which at the occipital portion of 
the head wer^ collected into a fasciculi of the same kind, six or seven inches long, 
between which, however, the disease was similarly conspicuous. But these 
few hairs were said to have only been produced by the greatest care and dili- 
gent washing, when the girl had desired to cultivate them for the improvement 
of her appearance. 



i^r. 



140 Bibliographical Notices. 

The colour of this crust upon the scalp was lig-ht yellow, but of a whitish cast, 
dirty or pulverulent at the upper part of the back, mammse, and surrounding 
parts, and of a dark leaden hue at the inferior part of the abdomen and back, at 
the haunches and leg-s; upon the hands and feet it was of a dirty -yellowish 
brown and olive hue. 

Besides these peculiarities, the whole of the thorax was covered with a sin- 
gularly loose and peculiar skin, which in some places, where the skin covered 
the bones only, as at the elbows and knees, formed singular rugse; in other 
places, as fo*r instance over the glutei muscles, it composed not less than 
sixteen or twenty regular semicircles. The rugosities of this diseased skin 
were so far peculiar to it, that when an attempt was made in the neck or 
places less affected by the common disease to enclose a portion between the 
fingers, innumerable rugze were immediately formed, which was not the case 
a few inches above in healthier places, or where there was a greater abundance 
of fat. 

But the diseased skin, in places deprived of this covering, appeared dry, 
harsh, and redder than elsewhere. The corpuscules were firmly adherent, as 
if rooted in the skin, and bled when torn off by force, though when the hard 
mass was seized with the forceps, they could be removed without pain. When 
this was done, a minute, (central,) style of a line in bulk was seen, whitish and 
softer than wax, which, however, when exposed to the aii-, was quickly harden- 
ed. These hard crusts were chiefly, and especially upon the arms, of a polish- 
ed appearance, and emitted a noise when they came in contact with hard bodies. 
Such is a succinct description of the affection, as observed by Dr. Schmidt 
in this unfortunate girl, of which M. Ahbert has thus spoken in the Diet, des 
Sciences Medicales: "I question whether such a remarkable phenomenon will 
occur again in the course of ages," &c. She was the third child of a family of 
four, the parents of which had been some time dead. Her father was a painter. 
The two brothers and a sister, which composed the rest of the family, were 
never in the least affected with this disease, nor are their children. 

The disease early made its appearance upon the skin of this female. It was 
observed, in fact, by the accoucheur, four or five days after birth; the skin of 
the infant presenting a hoary appearance, not removeable by ablution. Her 
mother likewise observed it, when she had recovered from her indisposition, 
and attributed it to the neglect of proper cleanliness, and many remedies were 
immediately applied, but without any effect. Finally, with the superstition com- 
mon to such persons, in the absence of palpable causes for any particular event, 
she attributed this affliction of her child to her having fallen into a lake, when 
pregnant with her and in perfect health, and her being taken sick immediately 
afterwards, after she had remained along time upon the trunk of a floating tree. 
The diseases to which she was subsequently exposed in her infancy were 
measles, scarlatina, varicella, and variola; the three first were light attacks, but 
the last affected her severely, and aggravated for a long time the congenital 
disorder. None of the variolous cicatrices were visible any where upon the 
skin, nor in any of the different periods of desquamation did she profess to have 
been entirely free from ichthyosis. She was also for a few days affected with 
icterus. There was some stiffness of the fingers of the right hand, and a diffi- 
culty in extending thenij which she attributed to an inflammatory swelling she 



Case of Congenital Ichthyosis. 141 

had experienced at the elbow jomt; in which there was some similarity, not 
perhaps entirely fortuitous, with the well-known case of John Lambert, who 
had little controul over the motion of the right hand, as was remarked by Thi- 
lesius, who attributed the cause to his having at too early an age been made to 
carry the weapons of the hunters. 

Frances Kroone at eighteen commenced to menstruate, which she subsequently 
continued to do at the usual period, and in large quantity. She was not subject 
to any peculiar diseases and enjoyed good general health. She was more affect- 
ed by cold than persons are usually, fond of a high temperature, and felt better 
in summer. In winter she was much annoyed by the coldness and dryness of 
the winds; when these prevailed, the fissures upon the feet would gape open, 
so as to admit a finger, and sometimes discharge blood. She perspired spon- 
taneously over the whole body, but especially in the arm-pits. During the cold 
season, she was obhged oftener than is usual with others to pass her urine, 
which however was nowise peculiar. Desquamation took place to more ex- 
tent at the vernal and autumnal equinoxes than at other periods. 

The crust upon the hands was not so much of an incumbrance but that she 
was able to use them in washing herself, and many other manipulations; latterly 
she had learned some artificial employments, and was able, with her eyes shut, 
to distinguish by the touch, metals, silk, paper, &;c. 

Her face and thorax were well formed, and appeared to indicate the same 
condition of the body; which, however, was not the case. For the extremities 
were emaciated, and there was great deformity resulting from an inclination of 
the pelvis, that made the glutei appear thicker and more monstrous, thereby 
rendering the defect in the legs below, so much the more conspicuous. Indeed, 
the inclination was so great, that it more than the diseased condition of her 
feet, rendered her gait vacillating and uncomfortable. Walking likewise ex- 
cited pain at the acetabula. 

Such, at least, are the material facts which, during the few days she remain- 
ed in the city of Bremen, were gathered respecting this interesting case, by Dr. 
Schmidt, partly from observation, and partly by inquiries from the individual 
herself. 

Simple ichthyosis, though a disease occasionally occurring, is almost unknown 
in Germany. This disease was termed by Dr. Schmidt a case of Ichthyosis cor- 
neae, and apparently with good reason, for upon other parts of the body, as 
well as upon the palms of the hands and soles of the feet, there were morbid 
productions of a horny nature. 

Ichthyosis has been considered by writers, viz. Thilesius, Alibert, Martin, See. 
as an hereditary disease, occurring generally in the first two or three months of 
existence; in this individual it was observed four or five days after birth. 

The hereditary nature of ichthyosis was conspicuous in the Lambert family, 
all the males of which, but none of the females, were affected for three gene- 
rations. M any cases exist to prove that it is not always propagated by diseased 
parents to their children, some escaping in the same family, while others were 
affected. There is proof also in the history of some females, as described by 
P. J. Martin, of its hereditary nature, in which it was transmitted from a mother 
to her daughter. It is stated by Eayer, that a man named John Brayer, and his 
brother, both sons of a diseased father, laboured under general ichthyosis, while 

13* 



142 Bibliographical Notices. 

their sisters, and their sisters' children, were entirely free, so that there is di- 
rect evidence of its having been transmitted from father to son, and from mother 
to daughter; this at least has been the case in simple ichthyosis, as experience 
has taught. 

The causes of ichthyosis is as yet unknown. It is supposed by Alibert, with 
some little tincture of the prejudice of the vulgar, that in maritime places, and 
along rivers where fish abound, the system, by being fed from their products, 
may be disposed to this disease; though he afterwards more courageously as- 
serts "that the causes of this disgusting and detestable disease is totally un- 
known." This supposition of M. Alibert, which is not wholly without sup- 
porters, may perhaps, with those fond of the marvellous, find an increase of 
support, from the fact that the mother of this girl, was, while pregnant with 
her, exposed in a lake upon the floating trunk of a tree, to the malignant 
glances of the watery basilisks. It is perhaps a sufficient trial of our credulity 
to attribute this intra-uterine derangement, (as others of an analogous nature 
are,) to the mental anxiety and dread of the mother, acting through the sym- 
pathetic nerves, which prudently observes Dr. Schmidt, he will neither admit 
nor gainsay. There now exists well-authenticated instances of sudden and sur- 
prising changes on the surface of the body from moral emotions, such as the 
turning the hair from black to gray in the course of a few hours, and similar 
effects in the rete mucosum. Where we cannot explain, it is safer and more 
manly to admit our ignorance, for then at least the road is open to improvement. 
Ichthyosis has by most writers been considered an affection of the epidermis 
only, though Thilesius considered it to Consist in a morbid state of the seba- 
ceous follicles of the cutis. Dr. Schmidt, for the following reasons, is disposed 
to coincide in opinion with the latter: partly because he has seen some of these 
horny tubercles occupying the site of these follicles, and partly because when 
they were carefully extracted, an elongation, having the appearance of a root, 
appeared to come from the follicles themselves. Besides, as the epidermis is 
a production of the subjacent rete Malpighi, any cause producing a morbid se- 
cretion of this structure, would give rise to an unusual epidermis. From this 
cause, the whole skin was affected in the case which forms the subject of this 
treatise, and there was in support of this opinion, an Unusual deficiency of fat 
over the whole body, and especially in the diseased parts, which produced per- 
haps the looseness and rugosity of the skin. However this may be, the secre- 
tion of the epidermis was changed both in quality and quantity. Admitting 
that these horny bodies consisted in induration of the epidermis, still the sud- 
den and peculiar hardening, and the great mass of the secretions, indicates such 
derangement of the nisus formativuSf as to confirm the opinion of the heredi- 
tary nature of the disease. 

These substances were chemically very analogous to the horn, hair, and shells 
of animals. 

That Frances, observes Dr. Schmidt, whose skin was thus covered, sweated 
freely over the whole body, appears to be owing to the peculiar pores lately 
investigated by Thomas Gordon Hake. In some places where no crust was 
found, the author is disposed to attribute the cause, to the profuseness of the 
sudatory discharge. In the same way he likewise accounts for the absence of 
the scales in the palms and soles of the Lambert family. Such, too, is nearly 



Parsons on Jinatomical Preparations. 143 

the opinion of Thilesius. In all the cases above referred to, no crusts were 
found in the axillae, which were attributed to the same cause, copious discharge 
of sweat; which the girl admitted was very abundant there, as was likewise de- 
monstrated by the hircine odour, and effects upon the vestments of the part. 

All the writers upon this disease assert that the individuals affected with it, 
though possessing a tolerable proportion of health, were nevertheless subject 
to rachites from their birth. 

In lighter cases of ichthyosis, and especially in infants, there is, in the opinion 
of Dr. Schmidt, more or less of the scrofulous diathesis present, and many of 
which are affected with crustx ladesR, but in all which cases he hkewise observ- 
ed a dryness and rugosity of the skin, as well as secretions analogous to that of 
ichthyosis upon the skin of those labouring under atrophy, tabes, and dropsyg, 
which appear to arise in a similar way from the lack of fatty matter peculiar to 
this disease, and to disappear when it was restored to the skin. 

Whether or.not, the extreme emaciation of the extremities in this female 
was owing to an affection of the whole lymphatic system, and to which the dis- 
order of her general health was to be ascribed, it is not possible, from the ob- 
servations given, to decide. The peculiarly melancholy expression of her fea- 
tures, is, however, well deserving of notice, a circumstance which Alibert asserts 
is not only always an attendant upon ichthyosis cornea, but likewise aggravates 
the disorder so much that stupidity may be the result, in consequence of the 
continued contemplation of their deformity and their gloomy prospects for the 
future. 

In regard to the colour of the crusts, much appears to depend upon the sex 
of the patient, and the peculiarity of location. "For why," it is asked, "does 
it appear darker upon the abdomen of the female, which is covered with clothes, 
than upon the hands and feet, always subject to exposure?" 

Dr. Schmidt likewise noted a singular and peculiar slimness of the first di- 
gital phalanges, in this female, of which, however, he has seen traces a few 
times in other diseased affections of the skin. In regard to this fact, he asks, 
"Whether it is to be considered as an indication of the severer cutaneous dis- 
eases, as, on the other hand, a thickness of the phalanges is noticed in those 
labouring under diseases of the heart and lungs?" 

Three very well executed plates accompany this case. The first exhibits the 
whole person, the second the hand and fore-arm, and the third the foot, the 
two last are of the size of nature. Dr. Schmidt's publication constitutes an in- 
teresting addition to our science. J. P. 



XIV. Directions for making Anatomical Preparations^ formed on the basis ofPole^ 
Marjolin^ and Breschet; and including the New Method of Mr. Swan. By Usher 
Parsons, M. D. Professor of Anatomy and Surgery. Philadelphia, Carey 8c 
Lea, 1831. 

Perhaps no single circumstance serves more to distinguish the state of medi- 
cal science at the present period, than the increased attention to healthy and 
pathological anatomy. While physiological medicine rejects all symptomatology, 
which does not consist in an accurate knowledge of the connexion between the 
appearances of disease and the actual condition of the part affected, it renders 



144 Bibliographical Notices. 

necessary a more accurate acquaintance with the normal state of all parts of the 
system, as it founds its high pretensions upon the revelations received from 
extensive examinations of diseased organs in every stage, and under all the va- 
rious circumstances of morbid action. The necessity and importance of frequent 
postmortem examinations are gradually acquiring the sanction of public opinion; 
so that among the enlightened, permission is now seldom refused to him who 
would investigate the cases of rare disease and sudden death, which occur in 
private practice; while in large cities the infirmaries and hospitals afford to the 
metropohtan practitioner the most ample opportunities for the prosecution of 
pathological anatomy. But the pursuit of practical anatomy, with a view to a 
minute acquaintance with the structure of the human body, requiring patient 
and protracted dissection, mutilating, and destroying the subject, has still to 
contend with public prejudice. And, although in most of the medical schools 
in this, and other countries, little difficulty is now experienced in procuring the 
necessary subjects, the appeal of the whole medical profession of Massachusetts 
is still sounding in our ears, and the self-devotion of the members of one of the 
most distinguished surgical colleges in Great Britain is still fresh in our remem- 
brance. Little, however, does it avail the great body of surgeons who are 
scattered among our villages and throughout the country, that dissection is 
readily prosecuted in our large cities. Too often they are compelled to under- 
take the most important operations, depending solely upon the recollection of 
their anatomical labours when students, and occasional references to text books 
and plates. Since the establishment of the principal medical colleges in our 
country, probably few leave them to enter into actual practice, who have not 
prosecuted practical anatomy, and prepared many pieces of dissection, which, 
if preserved, would have been invaluable to them in after life. In many places 
where practical anatomy is taught, the art of making and preserving prepara- 
tions has been but too little considered; and although some instructions are 
appended to many of the manuals of dissection which have been published in 
this country, the American press has produced no systematic treatise on the 
subject but the work now before us. Since the time of Ruysch and Munro, the 
art of making anatomical preparations had undergone but little improvement, 
until within a few years the labours of Dumeril, Breschet, Marjolin, Cloquet, 
Bell, Pole, and Swan have brought it to its present state of perfection. 
' Without making much pretension to originality, a claim which the very na- 
ture of the subject forbids, the work of Dr. Parsons, uniting the result of the 
individual labours of all his predecessors, with his own experience, is decidedly 
the best treatise on the art which we have seen. In the introduction, are con- 
tained some valuable remarks upon the economy of dissecting rooms, and the 
process of dissection, with practical observations on the diseases consequent to 
wounds produced by instruments when charged with some morbific matter 
present in the subject. Too often these cases are neglected entirely, until the 
occurrence of severe pain, tumefaction, and febrile excitement call urgently 
for relief. To meet these circumstances, the treatment recommended by Dr. 
Parsons is highly appropriate; but in considering the cure, the Dr. has omitted 
what we consider of even more importance, the prophylaxis. It may appear 
to be an unnecessary and timid precaution, but from considerable observation, 
we are convinced that if the wounds received in dissection were immediately 



Parsons on Anatomical Preparations. 145 

subjected to strong" suction by the mouth, and carefully washed with soap and 
water, recommended by the late Dr. Godman, we should have no more of these 
fatal cases; and when the subjects have died of inflammation and suppuration 
of the serous membranes, we think it should never be omitted. 

From the nature of this work, consisting- as it does, of plain and practical de- 
tails, it scarcely will admit of an analysis. Beginning with the ordinary mode 
of making injected preparations, we have in succession all the different forms, 
cerated and mercurial, dry , wet, and corroded. The difficulty of filling the 
minute veins of the extremities with coloured injection, has always been ac- 
knowledged, and the attempt has been almost abandoned. The ordinary mode 
of injecting these vessels with mercury, with the ingenious contrivance of our 
author for obviating the opposition presented by the valvular structure of the 
veins, and thus filling the extreme vessels with common injection from the 
large trunks, we shall give in his own words. 

*' Section XX. Injection of the arteries and veins of the hands and feet, with 
coloured injection for dissection and corrosion.- — These preparations have, I believe, 
never been made by any one but myself. Quicksilver has long been used for 
fining such veins, by supporting a column of it for some days in an artery going 
to the hand or foot, and then twisting a cord round the wrist or ankle, and 
drying and planting the preparation in a pedestal of wax or plaster of Paris, 
with the fingers and toes upwards. Such a preparation exhibits the superficial 
vessels very beautifully, and especially the nourishing arteries in the roots of 
the nails. No coloured injection has, however, within my knowledge, been 
made of the veins of the fingers and toes, that will admit of their dissection. 
Proceed in this as in the foregoing case, more particularly described in section 
56. When the arteries and veins are filled to running over, insert a pipe into 
one or two of the largest veins, and without tying the cord, let the part dry as 
soon as practicable; then shave a thin portion from the ends of the thumb and 
fingers or toes, and let the quicksilver run out from them, and also from the 
pipes by inverting the part. Then inject the arterial pipes with coarse cold 
red injection, and the venous pipes with yellow, white, or dark blue, continu- 
ing the pressure till the injection appears at the ends of the fingers. Pass a 
cord round the wrist and immerse the part in tepid water for a day or two, to 
restore the softness, so as to admit of dissection; or if the object be to make a 
corroded preparation, macerate for some months, and wash away the soft parts 
by a stream of water directed upon it, as described in directions for making 
natural skeletons of small animals. The obstacle that has hitherto presented 
itself to injecting the veins of the hand and foot, is their valves. But here the 
quicksilver, by its upward pressure, if continued till the valves are dried, throws 
them open, so that the injection flows contrary to the current of the blood, 
with perfect facility." 

In connexion with the subject of wet preparations, we cannot forbear to ad- 
vert to the method of preserving the natural colours in specimens of morbid 
anatomy, as quoted by our author, from an essay by Mr. Gaskoin, in the London 
Medical Gazette, for 1828. When on a visit to New York last summer, some 
morbid specimens in the cabinet of one of the most eminent surgeons of that 
city, prepared in the manner above alluded to, were submitted to our inspec- 
tion, which retain their original colours and appearance in a remarkable degree. 

Besides directions for all the various preparations of actual anatomy, wefind 
the methods of modelliag in plaster extracted from Pole; and a useful chapter 
on the preservation of subjects of comparative anatomy. In short, we consider 
the appearance of the work before us, as most opportune, at a time when the 



146 Bibliographical Notices. 

facilities of practising dissection and obtaining" specimens of pathclogical 
anatomy serve to render it peculiarly valuable. We therefore recommend it to 
the student and practitioner, as the best expose of the present state of the art 
of making anatomical preparations, and hope that it will be found in every dis- 
secting room, and in the hands of every one engaged in post-mortem exami- 
nations. 

With regard to the execution of the work, consisting as it does of plain prac- 
tical details, we can bestow no greater praise, than to say that the descriptions 
are for the most part clear, concise, and intelhgible; but with respect to the 
typography, we are sorry to observe many errors, which, though not important 
in themselves, would not have escaped a professional corrector of the press. 

T. C. D. 



3CV. A Manual of Medical Jurisprudence, compiled from the best medical and legal 
Works, comprising an account, 1st, Of the Ethics of the Medical Profession,- 2d, 
The Charters and Statutes relating to the Faculty; and 3d, Ml Medico-legal 
Questions, with the latest decisions.- being an Analysis of a course of Lectures 
on Forensic Medicine, annually delivered in London, &c. &c. By MicaAEi 
Ktan, M. D. &c. &c. London, 1831. pp. 309. 8vo. 

We have so often in our preceding numbers called the attention ®f the pro- 
fession to a branch of study, but too generally neglected in this country, 
•and to the benefits resulting from a competent knowledge of its principlesj 
that it would be superfluous to again repeat the arguments we have ad- 
duced in its favour. We have, however, been so much pleased with Dr. Ryan's 
work, and so well convinced that it is calculated to fulfil the intentions of the 
author, that we cannot forbear again soliciting the attention of our readers to 
this important subject. The main object of Dr. Ryan has been to afford the 
igreatest quantum of information in the smallest compass, and in the most fami- 
iliar manner; or in fact to simplify the subject as much as possible so as to render 
it intelligible to every class of medical practitioners, as well as to gentlemen of 
the bar, jurymen, and even general readers. This task the author has executed 
in a satisfactory manner, and although we do not agree with him in some points, 
■we are acquainted with no work on medical jurisprudence that presents so 
much valuable information in so condensed and yet so clear a form. Dr. Ryan 
lias freely availed himself of the labours of his predecessors in this department 
of knowledge, and we are glad to see the high estimation in which he holds 
the opinion of our countryman. Dr. Beck; who, to use Dr. R.'s words, and which 
must be echoed by all who have studied the " Elements of Medical Jurispru- 
dence," " is an ornament to his profession, and an honour to his country." It 
is one peculiar merit of Dr. Ryan's, that he frankly acknowledges his obliga- 
tions to his fellow labourers in science, and that he never avails himself of the 
observations of others without giving them due credit; this is so rare in the pre- 
sent book-making age, that we are happy in holding up our authors scrupulous 
attention in " rendering unto Caesar the things that are Caesar's," as an example 
by which we might all profit. 

The work is divided into three sections: the first is devoted to the consider- 
ation of the important subject of medical ethics— a subject so intimately con- 



Ryan's Manual of Medical Jurisprudence. 147 

nected with the standing and dignity of the profession, that it becomes a matter 
of astonishment that it has been so wholly overlooked of late years; "there 
never was a period in medical history in which ethics were so neglected and 
violated as in this *age of intellect,' nor the dignity of the science so de- 
graded and disregarded." Dr. Ryan first gives a sketch of medical ethics of 
Hippocrates and his eminent successors, and the influence they exercised on 
the profession; he then gives the ethics of the middle ages, which are followed 
by a consideration of those of the present day, as laid down by Gregory, Per- 
cival, &c. These chapters will amply repay an attentive perusal, and if the pre- 
cepts contained in them could be universally adopted, it would save us from 
the pain and disgrace of witnessing those constant squabbles among members 
of the profession which tend so powerfully to depreciate its standing with the 
public. 

The two next chapters relate to the laws of the medical profession which are 
in force in Great Britain and Ireland; many of these being mere local enact- 
ments, possess but little interest to the American reader; others, however, de- 
pending on common law, are equally in force in this country, such as the ha- 
bility of witnesses, &c. 

In the next chapter Dr. Ryan begins the discussion of questions of medical 
jurisprudence, by such as relate to disqualifications for marriage; these are 
either physical, moral or accidental, and the author justly deduces the follow- 
ing general principles, *' 1st, That to declare either sex impotent, it is necessary 
that certain physical causes be permanent malformations, or accidental lesions, 
evident to our senses. 2d, These causes when rigorously examined, are few 
in number. 3d, The moral causes ought not to be taken into consideration, as 
they would serve as an excuse for an individual accused of impotence." The 
chapter on pregnancy which succeeds, though short is clear, and the positions 
well laid down. Dr. Ryan appears to agree with Kennedy and others, that auscul- 
tation is the only infallible test of pregnancy. The next points discussed are 
those of abortion and delivery, on which as may be supposed, nothing new was 
to be said. In chapter XI. the author enters on the difficult subject of infanti- 
cide; with this part of Dr. Ryan's work we have not been as well satisfied as 
with the others, it is too short, and does not point out with sufficient clearness 
the numerous fallacies attendant on all the proposed tests of the life or death of 
the infant; in this part of his work he has made ample use of Dr. Beck's treatise, 
and which he appears to consider as the highest authority on the subject. 

The chapter on rape deserves attention; Dr. Ryan has adopted the opinion 
now beginning to be generally held, that there are no positive signs of virginity, 
as physical proofs are equivocal and may all be wanting, without giving rise 
to a well-grounded suspicion against the female. 

The author next discusses those medico-legal questions, that relate to at- 
tempts against health or hfe. This is done clearly and perspicuously, though 
we think he has omitted some important facts that might have considerable in- 
fluence on our decision. The observations on homicide by asphyxia, in which 
the author includes hanging, submersion, the introduction of foreign substances 
into the trachea, and the effects of the non-respirable gases, of course contain 
little that is new; those, however, on the poisons are excellent, and present a 
condensed view of all the recent information on the subject. We are glad to 



148 . Bibliographical Notices. 

see that Dr. Ryan makes such constant reference to the work of Chrlstison, 
certainly the first authority on this intricate subject that we possess, and one 
that we are astonished has never been repubhshed in this country. 

As respects the chapter on adulterations of alimentary matters, we must con- 
fess that it has always appeared to us that they are of much less importance 
than is usually attributed to them : notwithstanding it is now many years since 
Accum proved that death and disease lurked in every, mouthful that were swal- 
lowed, we do not find that mankind have been more cautious, or that they have 
materially suffered from their neglect of his peptic precepts. The adulteration 
of medicines is of much more vital interest, and we know that it is practised to 
a very great extent, not however, to the degree which Dr. Ryan states occurs 
in England; where he says it is almost impossible to procure a single article in 
the Pharmacopoeia in a genuine form. His remarks on the state of charlatanism, 
we are sorry to admit, are but too applicable to this country, ** where the most 
ignorant and illiterate persons are allowed, with reckless indifference, to assume 
the titles and privileges of educated medical men, to the destruction of human 
health and life." What encouragement is held out to the regular physician 
who has sacrificed health and property to the study of his art, when he finds 
himself superseded by some inspired pretender; when he sees the preparations 
of an illiterate nostrum-monger, recommended to the world under the sanction 
of some of the highest names in the profession? " But unhappily," says an able 
writer, '* it appears that John Bull and his family are not gifted with the power 
of being beware of hypocrisy, advertising charlatans and empirical nostrums; 
but through their proneness to gullability and love of the marvellous, the trade 
of quackery is daily increasing, and some hundreds of quacks swarm in every 
corner of the metropolis, and fatten on the murders which they are constantly 
perpetrating with their poisons." These remarks, though intended for London, 
are but too true of every large city in the United States, where wholesale 
quackery is full as rife as in any part of the world. 

The next chapter on mental alienation, although very short, contains a valu- 
able summary of legal decisions on this intricate medico-legal question. The 
shades and degrees of insanity are so various, and the definition of insanity as 
given even by the best authorities so vague and discrepant, that there are 
no cases in which a medical witness is called on for his opinion, that demand 
more circumspection and close observation. In fact, as is observed by Mr. Amos, 
"the degree and kind of insanity, which renders a person responsible for crimi- 
nal acts, is a subject upon which it is impossible to give precise and scientific 
notions." 

The chapters on simulated and disqualifying diseases are much too brief to be 
of much service. When a medical ma)* is called upon to examine individuals 
supposed to be labouring under certain diseases, the existence of which would 
exempt them from certain pubhc duties, or screen them from merited justice, 
he would grossly violate his obligations to the public, if he impeded the admi- 
nistration of the laws; in these cases he is not to be influenced by mere huma- 
nity, but is bound to give a correct decision according to the best of his skill and 
knowledge. 

The last chapter on medical evidence is very valuable, and though not equal 
to Dr. Smith's Treatise, will amply repay an attentive perusal. 



MedicO'Chirurgical Transactions. 149 

In the foregoing- short analysis of the contents of Dr. Ryan's volume, we have 
merely wished to apprise our readers of its contents, and the plan on which it 
is arranged; neither time or space have permitted us to enter on a review of 
the author's opinions, nor to dilate on the various questions of which he treats. 
An American edition of it, with such additions and alterations as may be requir- 
ed to adapt it to the jurisprudence of this country, would, we think, be a valu- 
able addition to our medical and legal libraries: not as a substitute for. the more 
extended work of Dr. Beck, but as a catalogue raisonnee of the various ques- 
tions in which jurisprudence calls on her sister science for elucidation, 

R. E. G. 



XVT. Medico- Chirurgical Transactions. Vol. XVI. Part II. London, 1831. 

pp. 236, 8vo. 

The portion of the sixteenth volume of the Transactions of the London Me- 
dico-Chirurgical Society, now under notice, comprises eight articles, all of 
which are more or less interesting. The first is an elaborate essay on omental 
hernia, by John" Macfarlane, M. D. of Glasgow. The omentum enters into the 
formation of nearly all the varieties of hernia, but from its position it is less fre- 
quently met with in those which pass out through the inferior apertures of the 
abdomen or pelvis. It is more frequently encountered in umbilical than in in- 
guinal, and in inguinal than in crural hernia. As it descends lower in the left 
than in the right side of the abdomen, it escapes more readily through the left 
inguinal opening than through the right; Dr. Macfarlane thinks that three- 
fourths of the cases of epiplocele are in the left groin. In some rare cases the 
omentum has escaped on both sides in the same patient, and in the same side 
it has been found to protrude through both inguinal and crural openings. 

This disease occurs more frequently in advanced than in early life; the omen- 
tum in the latter period being small; Dr. M. has, however, seen three cases of 
congenital rupture in very young children, in one of which the tumour appear- 
ed to consist wholly, and in the other two, partly of omentum. 

Epiplocele is less dangerous, and is usually attended with less urgent and 
alarming symptoms than intestinal rupture; nevertheless, in strangulated omen- 
tal hernia the symptoms are often extremely severe, and Dr. M. is of opinion 
that it requires a more active and prompt treatment than seems to be followed 
by the chief surgical authorities of tlie present day. 

The omental seldom attains the magnitude of an intestinal rupture; the en- 
largement of the tumour in the latter depending upon the repeated escape of 
new portions of bowel, while in the former it is more frequently to be attri- 
buted to the morbid enlargement of the displaced part. When the tumour is 
composed wholly of omentum, it usually presents an uneven surface, has a soft, 
doughy feel, and wants the tension and elasticity of enterocele. 

*' When the tumour is small, recent, and unchanged in structure, it is often 
ill defined; and when in this state, it occupies the situation of the ingniinal open- 
ing, it is apt to be mistaken for a partial enlargement of the spermatic cord; 
and even in an old irreducible epiplocele, the tumour sometimes presents ex- 
ternally a smooth and polished surface, with the tension, and other characters 
of an intestinal rupture. This is especially observable when the sac is distended 
with fluid; but even when this complication exists, we shall seldom fail, unless 

No. XVII.— Nov. 1831. 14 



150 Bibliographical Notices, 

the tension be very great, in recognising the hard and irregular omentum 
through the interposed fluid. The same uniformly smooth surface is occasion- 
ally met with, when the omentum contained in the sac is not consolidated, or 
otherwise morbidly changed, but is simply enlarged, from hypertrophy or obe- 
sity. Here, however, the absence of tension and elasticity, and the peculiar 
flabby state of the tumour, will render the diagnosis comparatively easy. 

*'The omentum, particularly when loaded with fat, escapes from the abdo- 
men more readily than the intestines, is reduced with greater difficulty, and re- 
quires a stronger spring truss to prevent its reprotrusion." 

In the employment of taxis for the reduction of epiplocele, Dr. M. recom- 
mends the avoidance of all violence or force, the omentum, when too much 
handled, being liable to be contused and lacerated. Dr. M. states that he has 
seen one case in which, from continued and powerful efforts at reduction, the 
omentum was lacerated in several places; and in another, the protruded part 
was livid and ecchymosed from the extravasation of blood into its cellular tex- 
ture. The contused omentum, instead of being excised, was, unfortunately, re- 
turned into the abdomen, became gangrenous, and produced death. 

** On the sudden protrusion of a portion of omentum, especially when it oc- 
curs for the first *^ime, we may expect to find the accompanying symptoms ex- 
tremely urgent. - Strangulation may be immediately produced, violent pain in 
the tumour and abdomen excited, with vomiting, hiccup, and obstinate consti- 
pation. In some cases an operation is indispensable, whilst in others the dis- 
tressing symptoms gradually yield, so soon as free alvine evacuations are pro- 
cured." 

The reduction of an epiplocele may be prevented, according to Dr. M. 1st, 
by adhesion of the omentum to the inner surface of the body, or neck of the 
sac. 2d. By enlargement of the omentum from engorgement of its vessels; the 
return of the blood through the veins being sometimes impeded by pressure at 
the hernial aperture. 3d. By the part of the omentum which passes through the 
neck of the sac being compressed into a hard, smooth cord, while the portion 
in the sac itself remains loose and capable of being expanded. This Pott con- 
sidered as the most frequent impediment to the reduction of an epiplocele. 4th. 
From its having undergone a morbid enlargement. Dr. M. has dissected a 
patient with a large epiplocele of the right side, which had been irreducible 
for fourteen years; the omentum was so enlarged and disorganized, that reduc- 
tion could not be accomplished until the inguinal canal was divided for nearly 
three inches. 5th. An epiplocele may be also irreducible from adipose enlarge- 
ment of the omentum, without any morbid alteration of the affected part, and 
this enlargement maybe accompanied with, or independent of general obesity. 
General evacuation causes a considerable absorption of the fatty matter of the 
omentum, so as to greatly reduce the size of the tumour, and occasionally to 
permit its return into the abdomen. 

" In irreducible hernise of large size, whether intestinal or omental, the pa- 
tient is not unfrequently subject to smart attacks of colic, with pains in the tu- 
mour, after taking a hearty meal. When the rupture consists wholly of omen- 
tum, the pain commences almost immediately after eating, but when of intes- 
tine the uneasy feelings are longer in appearing, and seem to take place only 
when the contents of the intestinal canal are passing through the tumour. Be- 
sides these symptoms, an irreducible epiplocele is often accompanied by severe 
dragging or twitching at the stomach, and by repeated vomitings} in conse- 



Medico- Chirurgical Transactions. 151 

quence of the stomach being compelled to follow the motions, communicated 
to i\\(i fixed omentum, by the intestines and abdominal muscles. These symp- 
toms are also most urgent after meals, because, from the distention of the 
bowels, the stomach is pushed up towards tlie diaphragm, and the omentum 
put more completely on the stretch, and also rendered more convex externally 
by the pressure of the intestines." 

As the stomach and colon become accustomed to the restraint arising from 
this unnatural fixture of the omentum, we occasionally find that the urgent 
symptoms gradually diminish, or even altogether disappear; a result, however, 
of less frequent occurrence, according to Dr. M. than we should be led to ex- 
pect from the assertions of writers. 

" When the distention of the abdomen is moderate, an irreducible epiplocele 
may cease to produce any disagreeable symptoms; but when the stomach is 
full, the bowels constipated, and unusually distended with flatus, or faeces, when 
much straining of the abdominal muscles occurs, we cannot fail to meet with 
very distressing symptoms. It is the liability of the abdomen and its contents to 
great and often to sudden variations in size, even in healthy individuals, that 
enables us to explain the repeated recwrrence of these painful paroxysms. 
They are generally more urgent when the omentum is suddenly, than when it 
is slowly, put on stretch; yet even in the latter state, they are sometimes mark- 
ed and severe." 

When an inguinal epiplocele has been long irreducible, the omentum some- 
times becomes so altered in structure as to produce, by pressure and irritation 
of the spermatic cord, a diseased state of the testicle, with or without effusion 
into the tunica vaginalis. 

"When an irreducible hernia is complicated with hydrocele," says Dr. M. 
" it would appear that the usual expedients for the cure of the latter disease can- 
not always be safely employed. The similarity of structure and contiguity of the 
affected parts is such, that when inflammation is excited by injection or other-- 
wise for the purpose of producing a cohesion of the tunica vaginalis, it is liable 
to be propagated to the omentum or its sac, and give rise to alarming symp- 
toms. It is also necessary to consider, before any operation is proposed, that as 
a preternatural collection of fluid sometimes takes place in the hernial sac it- 
self, which may present all the characters of hydrocele, great caution is requi- 
site in the diagnosis. 

** When the omentum is fixed to the sac by extensive adhesions, or when it 
is neither inflamed nor irritated, it is seldom that any great accumulation of fluid 
takes place. Sometimes, however, the sac is so much distended, as to prove an 
additional source of uneasiness to the patient. Pott was repeatedly obliged to 
puncture the sac and evacuate the fluid, in order to remove the inconvenience 
arising from the enlargement and weight of the scrotum; and when this was ne- 
glected, gangrene was sometimes produced. 

" To distinguish, therefore, between hydrocele complicated with an irredu- 
cible epiplocele, and a collection of fluid in the hernial sac, is of some practical 
importance. In the former, the fluid gradually accumulates in the most de- 
pending part of the scrotum, and extends upwards, leaving, as in the above 
case, a separation more or less marked between the two tumours. But, when 
the accumulation takes place in the sac, the swelling commences below the 
inguinal ring, and proceeds downwards, unless the hernia is scrotal, when it 
will begin in the same situation with hydrocele. We may expect, however, 
to find, when the fluid is confined to the sac, that the tense swelling is greater 
and higher up in the groin, and that the irreducible omentum is more com- 
pletely surrounded by it than in the other form of disease." 



152 Bibliographical Notices. 

It is the opinion of some writers, that when the local symptoms of a strangu- 
lated epiplocele are severe, and when they seem to depend rather upon inflam- 
mation than on strangulation, an operation is generally useless and frequently 
dangerous. Dr. M, on the contrary, asserts that an operation, even in these 
circumstances, may be not only necessary, but even highly successful, and he 
relates a case, which confirms his opinion. The operation will certainly be 
more successful when the omentum has protruded suddenly and become stran- 
gulated by the immediate pressure of the opening through which it has passed; 
but even when the disease is of long standing and irreducible, the additional 
size it requires when inflamed or engorged, says Dr. M. may cause over-disten- 
sion of the hernial aperture, and produce such painful and injurious constriction 
that an operation may become necessary. In this state the symptoms are less 
rapid in their progress, but as soon as tlie tumefaction of the omentum has ad- 
vanced to its greatest extent, the pressure at the ring may be as considerable, 
and the stricture nearly as complete as when directly produced by the escape 
of a larger piece of omentum than the opening can contain. 

Dr. M. recommends, in opposition to Hey, Scarpa, Boyer, Richerand, and 
other writers, that in epiplocele, the adhesions which the neck of the omental 
rupture may have contracted with the neighbouring parts should be separated 
and the omentum returned into the abdomen whenever it is practicable. 

" By permitting," sa3's Dr. M. "the divided omentum to remain fixed to the 
neck of the sac, a temporary closure of the aperture will be eflfected, and the 
immediate descent of any portion of intestine or omentum for a time prevented. 
But, on the other hand, besides the danger of the intestines adhering to, or be- 
coming entangled with, this fixed band of omentum, there is the risk of a se- 
cond hernia forming at the same aperture. When the abdominal muscles are 
called into powerful action, the fixed omentum serves as an inclined plane 
along which the intestines glide, and by which the impetus will be more effec- 
tually directed to the old hernial aperture, than to any other part of the abdo- 
minal parietes; and, of course, the risk of a secondary tumour forming, be 
greatly increased."* 

The permanent adhesion of the omentum to the inferior hernial openings of 
the abdomen, sometimes also seriously impairs the functions of the stomach and 
colon, the organs are dragged from their natural position, and instead of these 
organs gradually becoming accustomed to this restraint, it frequently happens 
that the symptoms adduced by it daily become more distressing, and continue 
to harass the patient with increasing severity during the remainder of life. Se- 
veral cases in confirmation of this are quoted. 

Besides, the disorganization to which the irreducible omentum is liable, is 
not confined to the tumour, but extends into the abdomen. Dr. M. says that he 
has seen one case and a preparation of the diseased parts of another, in which 
the omentum within the abdomen, as well as the portions contained in the irre- 
ducible ruptures, had lost every vestige of its natural structure, become exceed- 
ingly bulky, indurated, and tuberose, and produced death by exciting ascites. 

Dr. M. has found the use of cold, to an omental rupture, by means of ice, 
snow, or evaporating lotions, more successful in promoting reduction, than 
other external applications. 

* In omental hernise, wliicli have existed for years, a portion of gut not unfrequently escapes into the 
same sac, and becomes strangulated. 



MedicO'Chirurgical Transactions. 153 

Sir Astley Cooper once succeeded in reducing- an omental inguinal hernia, 
by applying- ice for four days. In robust and healthy subjects, Dr. M. says 
that cold appUcations may be continued for days with impunity; but when the 
patient is old and debilitated, their continuance for a few hours may be sufficient 
to destroy the vitality of the parts. The effects of cold must therefore be care- 
fully watched by the surgeon. 

Before returning the cut omentum into the abdomen, Dr. M. recommends 
that the bleeding vessels be individually secured, with fine ligatures. Sharp 
and Pott often returned the divided omentum without applying a ligature, and 
when the excised portion is small, and not materially changed in structure, little 
haemorrhage is to be expected; but when its volume is greatly increased, and 
morbidly altered, the vessels will be increased in the same proportion, and may 
require to be tied. Hey met with two cases where from not having tied the 
bleeding vessels before the omentum was replaced in the abdomen, haemor- 
rhage occurred which nearly proved fatal. 

Suppuration, although rather uncommon, sometimes takes place in the sac of 
an irreducible omental rupture. Le Dran mentions a case in which the pus en- 
tered the abdomen and proved fatal, and Dr. M. relates another, in which, how- 
ever, the diseased state was more circumscribed and the result more fortunate. 

Some of the older nosologists attempted to point out the prominent and dis- 
tinctive symptoms of idiopathic inflammation of the omentum, so as to establish 
the means of distinguishing this disease from peritonitis or enteritis. Dr. M. 
thinks, however, that we shall seldom succeed in distinguishing the disease dur- 
ing life. It is only when the inflammation commences in an omental rupture, 
and extends to the abdominal portion of this membrane, that we can correctly 
ascertain its seat and existence. 

Dr. M. states that he has frequently evacuated the fluid of ascites, by punc- 
turing the sac of an old umbilical hernia, not only with safety, but with greater 
facility, and less inconvenience to the patient, than if the usual situation had 
been selected, and the practice is sanctioned by Sir A. Cooper. 

An omental rupture is liable to be mistaken for a variety of diseases. 

*' When an intestinal hernia contains solid faeces, it presents some of the most 
prominent characters of an epiplocele. The history of the disease will, how- 
ever, enable us to arrive at a correct conclusion. 

"Hydrocele of the spermatic cord, varicocele, &c. have also some resemblance 
to an inguinal epiplocele. It has likewise been mistaken for a common hydro- 
cele. 

" x\.dipose tumours are sometimes attached to the sheath of the spermatic cord, 
immediately exterior to the inguinal ring; but more frequently, they are formed 
within the abdomen, in the cellular texture which connects the peritoneum to 
the neighbouring parts, and are protruded through the ring. They thus occu- 
py the position, and possess all the external characters of an inguinal epiplo- 
cele; and often render a diagnosis impracticable. 

*'When small in size, they can be reduced with facility, and prevented from 
again escaping, by the application of a truss; but when large, or indurated, 
they continue irreducible, and it is in this state they are likely to engage the 
attention, and baffle the skill and tact of the surgeon. Pelletan relates, in his 
"Clinique Chirurgicale,"* several curious cases of such tumours. 

** In nearly all the recorded cases, where the adipose tumour originated with 

* Tome III. p. 33, &c. Paris, 1810. 
14* 



154 Bibliographical Notices. 

the abdomen, the peritoneum was pushed before it, so as to form a sac analo- 
gous to a hernia. But, in the only case of this kind, which I have had an op- 
portunity of examining-, the tumour was found to have originated in the cellu- 
lar texture exterior to the peritoneum, close to the outer edge of the internal 
inguinal ring, and to have descended along the cord, and formed, externally, a 
large pyriform tumour, without being invested by a peritoneal sac. This tu- 
mour, which was irreducible, was supposed to be an epiplocele, although not 
accompanied by any of the symptoms usually attendant on this disease. This 
opinion was confirmed by the existence, at the same place, of an intestinal her- 
nia, which could be easily reduced, and retained within the abdomen. 

** After death, which was occasioned by pneumonia, the peritoneum was found 
dragged through the inguinal canal, by the descent and weight of the tumour, 
so as to form a sac, into which the intestine passed. The appearance of the tu- 
mour, when exposed by dissection, and its texture, when divided, so closely re- 
sembled the adipo-fibrous degeneration to which the omentum is occasionally 
subject, as to render it impossible to distinguish between them. 

" The nature of the disease was only correctly ascertained, by finding that the 
tumour was exterior to the hernial sac, and that the omentum was unconnected 
with the tumour, and occupying the upper part of the abdomen." 

The succeeding article, entitled, "Some considerations with respect to the blood, 
founded on one or two very simple experiments on that fluid, by Benjamik G. Ba- 
BiifGTOTvr, M. D., is an extremely interesting one. The principal experiment to 
which Dr. B. alludes, is the following: . 

Experiment I. — ** Let blood be drawn in a full stream from the vein of a per- 
son labouring under acute rheumatism, in a glass vessel which should be fi^lled 
to the brim. By close inspection a colourless fluid will be immediately per- 
ceived around the edge of the surface, and after a rest of four or five minutes, 
a bluish appearance will be observed forming an upper layer on the blood, 
which is owing to the subsidence of the red particles to a certain distance below 
the surface, and the consequent existence of a clear liquor between the plane 
of the red particles and the eye. Let now a spoon previously moistened with 
water, be carefully immersed into the upper layer of liquid by a.gentle depres- 
sion of one border. The liquid may thus be collected quite free from red par- 
ticles, and will be found to be an opalescent and somewhat viscid solution per- 
fectly homogeneous in appearance. By repeating the immersion we may collect 
this "fluid in quantity and transfer it to another vessel. That which I employed, 
is a bottle holding about 180 grains, of globular form, with a narrow neck and 
perforated glass stopper. 

" The solution with which the globular bottle is filled though quite homoge- 
neous at the time it is thus collected, is found after a time to separate into two 
parts, namely, a clot of fibrine which has the precise form of the bottle in which 
it was gathered, and a clear serum possessing all the usual characters of that 
fluid." 

This experiment shows that buffed blood consists of only two constituents, 
the red particles and a liquid, which Dr. B. terms Liquor Sanguinis. 

It was long ago observed that what is called inflamed blood, coagulates 
slower than healthy blood, and that the last portions of blood drawn from an ani- 
mal bleeding to death, coagulated quickest. The following appears to be the 
immediate cause of a buffed crust. 

" The blood consisting of liquor sanguinis and insoluble red particles, pre- 
serves its fluidity long enough to permit red particles, which are of greater 
specific gravity, to subside through it. At length the liquor sanguinis sepa- 
rates, by a general coagulation and contraction, into two parts, and this phe- 



Medico-Chirurgical Transactions. 155 

nomenon takes place uniformly throughout the liquor. That part of it throug-h 
which the red particles had time to fall, furnishes a pure iibrine or buffed 
crust, while that portion into which the red particles had descended, furnishes 
the coloured clot. This in extreme cases may be very loose at the bottom, from 
the great number of red particles collected there, each of which has supplanted 
its bulk of fibrine, and consequently diminished its firmness in that part. There 
is, however, with this limitation, no more fibrine on one part of the blood than 
another." 

The above account of the cause of the buffed surface on blood, aff'ords us an 
explanation of the well known fact that this phenomenon is influenced by the 
shape of the vessel in which the blood is received. The space left by the gra- 
vitation of the red particles, bears a proportion to the whole perpendicular 
depth of the blood, so that in shallow vessels scarcely any buffed coat may ap- 
pear, where the same blood in a deep vessel would have furnished such a coat 
of considerable thickness. Dr. B. moreover asserts that the quantity of crassa- 
mentum is also dependant, within certain limits, on the form of the vessel em- 
ployed. If this be shallow, the crassamentum will be abundant, if approaching 
in form the cube or sphere, it will be scanty. This diff'erence is owing to the 
greater or less distance of the coagulating particles of fibrine from a common 
centre, which causes a more or less powerful adhesion and contraction of these 
particles. Dr. B. is, we believe, the first to notice this fact, and there are per- 
haps few relating to the phenomena of venesection, of more practical import- 
ance; since blood is said to be thick or thin, rich or poor, in reference to the 
quantity of crassamentum it contains, and views of a disease are founded on 
these supposed conditions, which after all depend not on the blood itself, but 
on the vessel into which it is received. 

To obviate the objection which may be urged against a general conclusion 
. drawn from the experiment just alluded to, that it was made upon blood in a dis- 
eased state, Dr. B. receivedsomehealthy blood in a tall glass vessel half full of 
oil, which enabled its red particles to settle more quickly than would otherwise 
be the case. This blood was found to have a layer of liquor sanguinis, which form- 
ed a buffed coat, whilst a portion of the same blood received in a similar vessel, 
having no oil, had no inflammatory crust, as it is called. Hence it appears that 
healthy blood is similarly constituted as blood disposed to form a buff'ed crust, 
the only diff'erence being that the former coagulates more quickly than the 
latter. 

The first experiment also shows that the liquor sanguinis is an uniform homo- 
geneous fluid, and no mere mixture of fibrine and serum, for as already ob- 
served, the clot formed by the liquor has the precise shape of the vessel in which 
it is received; hence the coagulation takes place uniformly from every part of 
the fluid, and the uniform density of the clot confirms this conclusion. 

Dr. B. is also led to believe that fibrine and serum do not exist as such in cir- 
culating blood, but that the liquor sanguinis when removed from the circula- 
tion, and no longer under the influence of the laws of life, has then, and not till 
then, the property of separating into fibrine and serum. This separation which 
may be considered a death of the blood, may, under disease, take place within 
the body, but never, he thinks, consistently with healthy action. 

It follows from these views that there is no such animal fluid as coagulable 
lymph. 



156 Bibliographical Notices. 

** The liquor sanguinis," says Dr. B. *' cannot with propriety be so considered, 
for it is essentially a fluid, and if under certain circumstances it separates into 
two parts, only one of these (fibrine) is coagulable, nor can I admit that this 
one part, considered by itself, previously existed in a fluid state, for in order to 
its fluidity it was necessary that the two constituents should be so united as to 
form one compound. There is, therefore, no better reason for affirming, that 
fibrine exists in a fluid state in liquor sanguinis, than for affirming that muriatic 
acid exists in a solid state in muriate of ammonia. The salt, indeed, is solid, of 
which muriatic acid forms one ingredient, but the ammonia is essential to the 
solidity of the compound. In like manner, the compound is fluid, of which 
fibrine forms one ingredient, but the serum is essential to its fluidity. 

**Nor is it an unimportant error to suppose a fluid secreted from the blood 
which has the property of becoming converted into a solid, for we are thus led 
to overlook altogether the fluid portion of the compound with the albumen con- 
tained in it, which always forms by far the greater portion of the secretion." 

The fact of circulating blood consisting of a homogeneous liquor and red par- 
ticles, has led Dr. B. to the belief that when an effusion of serum takes place, 
we shall generally, in some neighbouring part, find a corresponding deposition 
of fibrine. Dr. B. does not believe that serum is a secretion intended for the 
lubrication of closed membranes, but says that such belief is a fallacy founded 
on appearances observed after death, which do not exist during life. 

** When we recollect," says he, "how quickly the separation of liquor san- 
guinis into serum and fibrine takes place out of the body, we ought not to be 
surprised to find, though it be but a few minutes after death, or even before it, 
if dissolution be gradual, a serous eff'usion into cavities which, during health, 
could not be destined to contain any fluid. 

"I doubt the fact, however, that such membranes have the power during 
health of secreting serum, by which term I mean a fluid essentially containing 
albumen; or that any thing more passes from them than an aqueous halitus, or 
vapour; and I therefore doubt the propriety of giving them the denomination 
of serous membranes. Under morbid defect of vitality they may and do suffer 
serum to exude from them containing more or less albumen, and in such cases 
we shall usually find effused into some neighbouring part the corresponding 
fibrine, which with the serum in question went to form the liquor sanguinis. 
Such membranes may pour forth the liquor sanguinis itselt^ in which case we 
shall find the separation to have taken place in the cavities which they line. 
Gelatinous masses will gravitate to their lowest parts, or flakes, or shreds of 
fibrine will be diff'used through the fluid. 

*' Wherever this gelatinous formation exists, it is owing to the presence of 
fibrine, since, as is well known, albumen never assumes a gelatinous form, un- 
der the ordinary temperature. We may indeed with albumen, when mixed with 
water and heated, exactly imitate this appearance of fibrine, and form substances 
of all degrees of gelatinous consistence; but this only serves to confirm the be- 
lief that fibrine, in a diluted state, may put on a gelatinous appearance on coagu- 
lation. I have stated that closed membranes may pour forth serum or liquor 
sanguinis. They may also, under high excitement, pour forth blood itself. 
There is, therefore, no better reasons for calling such membranes serous, than 
for calling them fibrinous or sanguineous membranes. The secretion of each is 
morbid, and we ought not to designate parts from the morbid actions which 
may be set up in them." 

The examination of fluids effused into closed cavities, throws much light upon 
this subject, and Dr. B. has off"ered several illustrations derived from that 
source. These are scarcely susceptible however of analysis, and our limits will 
not permit us to insert them entire. 



( 



Medico-Chirurgical Transactions. 157 

Before 0108*1115 our notice of this interesting* paper, we must allude to the 
great resemblance between liquor sanguinis and chyle. The principal differ- 
ence indeed existing between them is the red particles in the former, which 
it is evident are not derived from the latter, and that we must seek for their 
formation in some of the viscera connected with the circulation. The spleen 
has been looked upon as their secreting organ, and it may be interesting to 
state, that Dr. B. has examined with the most accurate and powerful micro- 
scopes the blood of a dog, whose spleen had been removed several months 
previously, and on comparing it with that of a healthy animal, it did not appear 
deficient in the quantity of its red particles. 

The third article is on the symptoms attending the change of a circumscribed 
popliteal aneurism into the diffused state, with some particulars of an aneurism of 
the aorta which burst into the oesophagus. The author of this paper, Samuel 
Cooper, Esq. is of opinion that there are certain particulars relating to the 
change of an aneurism from the circumscribed into the diffused state, which re- 
quire greater attention than they have yet received, and that without this at- 
tention the obscurity sometimes prevailing in the diagnosis will be the occasion 
of many errors in practice. 

> 
"It is not enough," he says, "to be informed, that when the aneurism be- 
comes diffused, its pulsations are reduced, or stopped, and the limb painful, 
with an alteration in the shape of the swelling, coldness of the foot, and a sen- 
sation, experienced by the patient, of something having given way in the limb. 
Frequently, there is rather a complaint of numbness, than of pain; and if the 
aneurism be large, the compressed and altered state of the popliteal nerves, and 
the effect of distention on the branches of the cutaneous ones, will fully accoutit 
for the general torpidness of the whole leg. With respect to a sudden change 
in the shape of the swelling, whether this symptom occur or not, will depend 
upon the situation of the opening formed in the sac, the extent and place of the 
extravasation, and the degree of cedema affecting the integuments. If the sac 
give way at a superficial point under the skin; the blood be effused in consi- 
derable quantity; and the limb be not already much enlarged from the oedema- 
tous state of the integuments; there will of course be a very manifest alteration 
in the shape of the swelling, and an evident and sudden extension, or increase 
of it. But, in the opposite conditions, that is to say, when the sac bursts at a 
very deeply seated point, when the blood is consequently injected into the 
cellular membrane between the muscles, and under the fascia; and when the 
integuments are already considerably thickened and swollen; a vast quantity of 
blood may be extravasated, without any remarkable change in the figure of the 
aneurismal tumour, or any very palpable increase in the tension and magnitude 
of the leg. As for the patient's having felt something break, or give way in 
the limb at the moment when the sac burst, it is a kind of information not con- 
stantly to be obtained, because the rupture is sometimes very limited at first, 
or may happen during sleep; and when the sensation is declared to have been 
experienced, little reliance can be placed upon the account, inasmuch as pa- 
tients, with popliteal and other external aneurisms, frequently complain of 
cramp, and sudden attacks of extraordinary feelings in their limbs, without any 
change of the disease from the circumscribed into the diffused form. 

"When the sac of an aneurism has burst in the foregoing manner, the pro- 
pulsion of blood into it from the heart, can evidently no longer have the effect 
of producing a full and sudden distention of it, as more or less of that fluid will 



158 Bibliographical Notices. 

either escape from it into the cellular membrane, or collect in one mass out of 
the orig"inal sac. Sometimes, however, when the breach in the sac is under a 
certain size, the pulsations do not completely stop at first; their strength is only 
reduced; and several days may elapse before there is a total cessation of them. 
Now, unless we suppose, that the opening- in the sac enlarges after its first for- 
mation, and that the subsequent decline and stoppage of the throbbing of the 
tumour, can be explained on this principle, we must look into other circum- 
stances for an elucidation of this interesting fact. 

"In a case of the preceding description, several causes combine to render the 
pulsations weaker and weaker, and at length to extinguish them. 

**lst. The more or less impeded state of the circulation, that takes place in 
the limb, as soon as a considerable quantity of blood has been injected into the 
cellular tissue. And, in order that the extravasation may attain the degree ne- 
cessary for the full production of this effect, a certain time is obviously requi- 
site; the limited size in the opening of the sac, and perhaps also sometimes the 
particular situation of it, away from the main current of blood, preventing the 
effusion from becoming all at once copious and extensive. By degrees, how- 
ever, the quantity of blood in the cellular membrane increases; and then its 
pressure not only creates a great deal of irritation, but actually interferes with 
the regular supply of blood and nervous influence to the limb. Hence, the 
alarming fall of temperature in the foot, and the well known tendency to gan- 
grene, consequent to the change of a circumscribed popliteal aneurism into a 
diffused one. 

'* 2dly. Another cause, that has a powerful effect in gradually putting an end 
to the pulsations, is the increase in the quantity of coagulated blood andfibrine 
in the sac; tlie inevitable result of the stream of blood through it becoming 
more and more retarded, in proportion as the obstruction of the circulation in 
the leg is augmented." 

Mr. Cooper illustrates these remarks by a very interesting case of popliteal 
aneurism,in which there was a rupture of the sac without any change in theshape 
of the tumour, diminution of its firmness, or material increase in the swelling^ 
of the leg; gangrene resulted, and amputation of the limb became necessary. 

In popliteal aneurisms of considerable size, there is always peril in delaying 
the application of a ligature to the femoral artery; for although there may be 
no immediate danger of the skin giving way, and of the patient losing his life by 
haemorrhage, the sac is apt to burst, and the disease to change from the cir- 
cumscribed into the diffused state, with all the disadvantages and risk insepa- 
rable from the latter condition. 

"By delay we suffer the muscles of the knee to become permanently injured in 
their organization; a prodigious sac to be formed, which will require a great 
length of time to be diminished and absorbed; the popliteal nerve to be con- 
verted into a thin expansion, not resembling its original structure; the popli- 
teal vein to be obliterated; and the condyles of the femur and head of the tibia 
to be in part destroyed by the pressure of the disease." 

The most remarkable points in the case of aneurism of the aorta, is that the 
basis of the scapula was displaced by the aneurismal tumour, and that the patient 
lived nearly eight weeks after a communication had been formed by ulceration be- 
tween the aneurismal cavity and the oesophagus, and followed the laborious oc- 
cupation of a wheelwright during a considerable part of this time. 

In the ninth volume of the Society's transactions a case is recorded of axil- 
lary aneurism in which the subclavian artery was secured above the clavicle, by 



Medico-Chirurgical Transactions. 159 

the late Professor Post of New York, the first we believe of the kind in which 
the operation succeeded. In the thirteenth volume of the same work a similar 
case, in which that operation was successful, is related by Mr. Key, and in the 
volume now under notice, two cases are given in which the operation has been 
attended with equally fortunate results, one by Mr. Crossing of Devonport, the 
other by Mr. Mayo. 

Mr. Crossing's patient was a stout, muscular man, forty-six years of age; the 
tumour was situated immediately under, and closely in contact with the right 
clavicle, extending to the cartilage of the fifth rib, stretching into the axilla, 
and over the point of the shoulder. It has a very tense, elastic feel, and the 
pulsation is generally rather obscure, but at other times is so distinct as to be 
seen at a considerable distance from the patient. The tumour is not compressi- 
ble, but the pulsation can always be stopped by pressing on the artery above 
the clavicle. The arm from the shoulder to the extremities of the fingers is 
swollen to an enormous size; is benumbed, and has lost all power of motion^ 
The pulsation at the wrist cannot be felt; and the arm is kept nearly at a right 
angle in consequence of the magnitude of the sweUing in the axilla, the pec- 
toral muscle and integuments covering it being stretched to the greatest extent. 
He is always in pain, and at times to a most agonizing degree; is unable to lie 
back in the bed, but is continually in a sitting position, with the arm support- 
ed on a pillow, and the body bent forward. His countenance is marked with 
great distress. 

The operation was performed June 23d, 1830, in the following manner. The 
patient was seated in an arm chair, the head directed to the left side. The in- 
teguments over the clavicle being stretched upon the chest, Mr. C. commenc- 
ed his incision near the sternal attachment of the mastoid muscle, and cut freely 
on the bone for about three inches and a half, thus dividing at once the inte- 
guments and platysma myoides. The parts being now allowed to retract, left 
the lower margin of the incision half an inch above, and running nearly paral- 
lel with the clavicle, and exposed the jugular vein to a considerable extent, 
which was easily drawn aside and kept out of the way with a blunt hook. The 
cervical fascia was next carefully divided from the clavicular edge of the sterno- 
cleido mastoideus to near the extremity of the wound, which brought into view 
the omo-hyoideus. This muscle instead of forming a triangular space, as it does 
in most instances with the scalenus anticus and clavicle, ran in a line with and 
just above that bone. Finding this rather unusual course of the omo-hyoideus 
an impediment, Mr. C. passed a director under and divided it. The knife 
was now laid aside, and the remaining part of the operation finished with the 
fingers and a common director. Some loose cellular membrane, and a large 
fatty gland being removed, the artery was found immediately below this sub- 
stance, and three considerable branches of nerves passing over the vessel, and 
in close contact with it. These were separated, and the ligature passed under 
it, and tied in a double knot. One end of the ligature was cut off close to the 
artery, the other left hanging from the wound, the edges of which were now 
brought together, and secured with one suture and adhesive straps. Nothing 
very remarkable occurred during the progress of the cure— the ligature was 
retained until the eighty-fifth day. On the 28th of December following, the 



160 Bibliographical Notices. 

man's health is stated to be perfectly good, the circulation free and perfect 
throughout the limb, and nothing left of the tumour but a little thickening in 
the sac of the aneurism, along the edge of the pectoral muscle. There re- 
mains, however, some want of strength and sensation in the limb. 

The gland described as existing in this case immediately over that part of the 
artery which was tied, Mr. C. thinks would prove a better guide in thjs opera- 
tion than the scalenus muscle. Mr. C. thinks that this gland will usually be 
met with; he says, that in not less than a dozen subjects whom he has examin- 
ed, it was found precisely in the same situation. 

The subject of Mr. Mayo's case was an athletic man aged forty-nine. The tu- 
mour was seated beneath the left clavicle, was four or five incheslong and three 
in depth, and. caused violent gnawing pains about the shoulder, breast, and 
back, from the irregular distention it occasioned of the axillary plexus of nerves. 
The operation was performed on the 26th of March, 1831, and is thus de- 
scribed: — , 

" Drawing down the skin of the neck, I made an incision about three inches 
and a half in length on the surface of the left clavicle, extending from the in- 
sertion of the sterno-cleido mastoideus muscle to the clavicular portion of the 
trapezius; by this the platysma myoides was exposed, which, as well as the sub- 
jacent fascia, I carefully divided, for upon the latter many branches of the ex- 
ternal jugular vein were found, several of which I was obliged to divide in the 
progress of my dissection through the cellular substance, and secure them with 
ligatures. I traced the edge of the omo-hyoideus muscle, traversing the upper 
part of the wound, and directly below it I could place my finger on the artery 
as it passed over the first rib, which seemed to be about an inch and a half or 
two inches from the surface; to this point I directed all my attention, and en- 
deavoured to clear my way to the artery by cautious touches with the edge of 
the scalpel, and by tearing the cellular substance with its handle, and with a di- 
i'ector, till at length 1 was^able to get my nail upon the rib and then under the 
artery, so that after various efforts I passed a common blunt aneurismal needle 
under it, armed with a strong round ligature, and having ascertained that nothing 
else but the artery was included in, the ligature, I ti^d it with a double knot, 
drawing each knot tight with the iron rings invented by the late Mr. Ramsden. 
The subclavian vein appeared just Within and below the superior border of the 
clavicle, but formed no impediment to the operation; the branches of the ex- 
ternal jugular, liowever, were very annoying, and kept the wound continually 
filled with blood, and the apprehension of wounding larger branches limited 
the extent of the internal wound to two inches at most. He bore the operation 
with great courage, though with some impatience, as it occupied rather more 
than twenty minutes; the pulsation ceased, and the pains in the shoulder were 
much relieved. 

The ligature came away on the, eighteenth day, and on the 2d of May the 
wound had completely cicatrized, the tumour had quite disappeared, and the 
arm was recovering its strength, but the pulse was not to be felt at the wrist. 

Dr. JoHiy Vetch, in a brief communication, extols the effects of tobacco as a 
local application in gout and'^other cases of constitutional inflammation. Dr. V. 
says that this article is capable of alleviating in a great degree, and sometimes al- 
together arresting various forms of specific inflammation, particularly rheumatism 
and gout, and that in this last disease it also assists the parts most materially in 
recovering their tone and strength. He adds that it is also a valuable applica- 



MedicO'Chirurgical Transactions. 161 

tion in all cases of erysipelatous inflammation, and that the only precaution to 
be attended to, is not to apply it to any part contiguous to the stomach, unless 
the production of nausea be at the same time desirable. He equally recom- 
mends it in acute migratory inflammation, attacking the testicle or sclerotic 
coat of the eye. Dr. V. employs the infusion made according to the London 
Pharmacopoeia, and in many cases he says it will be well to rub the part with 
eau de cologne, after the use of the tobacco. 

The history of a case, in which, on examination after death, the pancreas was 
found in a state of active inflammation, by William Lawrence, Esq. constitutes 
the seventh article. This case is interesting, both from the circumstance of 
morbid changes in the structure of the pancreas being extremely rare, and also 
because it connects the symptoms and progress of the aff'ection with the morbid 
changes which were produced. 

The subject of this case was a lady, twenty-one years of age, who, about the 
fifth or sixth month of her pregnancy, lost her usual healthy appearance, and 
gradually became pallid, but without feeling unwell. About a month previous to 
her confinement, she had a severe attack of catarrh, with very little fever, and 
which yielded 1o the usual remedies. The morning on which her labour com- 
menced, (the 29th of January,) she looked and felt extremely exhausted. The 
presentation was natural, the pains returning at pretty regular intervals, and 
she was delivered of a healthy child. The placenta was expelled by the con- 
traction of the uterus five minutes afterwards, and she did not, during the whole 
labour, lose two ounces of blood. The night after her labour was passed with- 
out pain; she was tolerably tranquil, but got little sleep. It was evident on the 
third day after her delivery, that although the labour was comparatively easy, 
she had suffered much from the exertion. She felt so exhausted that she was 
constantly calling for sal volatile to smell, and occasionally to take internally, 
in order to prevent fainting: she'sighed deeply and frequently. The least at- 
tempt to raise her head from the pillow produced a violent beating in the tem- 
ples, but it subsided after a few minutes of perfect quietude. Her pulse was 
feeble and irritable, at about eighty-six beats in a minute. The bowels were 
rather relaxed. 

Her state and symptoms were like those of persons who have lost large quan- 
tities of blood; and her medical attendant considered that there was a defect in 
the process of sanguification. Under this view of the case, which was adopted 
by a physician who saw her soon after her confinement, cordials and stimuli, 
both medical and dietetic, were resorted to. No advantage resulted from this 
plan, and another physician was called in, who recommended calomel and 
opium, on the idea that inflammation had taken place in the chest, and that ef- 
fusion had probably been the consequence. Mr. L. saw her about thirty-six 
hours before death, when no hope of recovery could be entertained. She was 
excessively pale, with a rapid, feeble pulse, hurried breathing, some fulness and 
uneasiness on the right side of the abdomen. 

Mr. L. says that he afterwards learned that this lady had been most singularly 
troubled by thirst during her pregnancy, and that her mother, alarmed by her 
drinking cold fluids in large quantity, had represented to her that she feared 
No. XVIL— Nov. 1831. ^5 



162 Bibliogrciphical Notices. 

the circumstance might prove injurious to the child. She had also suffered 
much from pain in the epigastric region, which was sometimes so severe as to 
oblige her to retire to her own apartment. In mentioning this circumstance, 
her mother drew her hand across the abdomen in the seat of her daughter's 
sufferings, and she pointed exactly to the situation of the pancreas. 

She however declared to her physicians, who attended during and after her 
confinement, and who examined her abdomen several times to discover if there 
was tenderness there, that she felt neither pain nor soreness on pressure. 

Examination thirteen hours after death. — "The body had not lost its heat; the 
internal parts were warm to the touch. The skin was universally and extremely 
pale. Nq blood escaped on making the incisions necessary for exposing the 
abdomen and thorax and for sawing round the skull. 

*• The membranes lining the abdomen and thorax, and the viscera contained 
in those cavities, excepting the pancreas and spleen, were extremely pale and 
almost bloodless. The appearance was like that observed In persons who have 
died of haemorrhage, or under the state described by the term anemia. The 
liver and kidneys were pale, and the several portions of the alimentary canal 
quite white, without any traces of blood in them, 

*'The heart was pale and rather large; its cavities and the contiguous large 
vessels contained some fluid of watery consistence, about the colour of red wine, 
and small portions of soft coagula. The coronary vessels contained no blood. 
The muscular substance of the heart was pale and rather flaccid: the structure 
of the organ in other respects was natural. The lungs were healthy, except 
that frothy fluid escaped on cutting into their posterior part. The cellular tex- 
ture around the pancreas and duodenum, the great and small omentum, the 
root of the mesentery, the mesocolon and the appendices epiploicae of the arch 
of the colon were loaded with serous effusion. The fluid, which was transpa- 
rent, bright yellow, and of watery consistence, ran out in large quantity on 
cutting into the parts above mentioned, which were distended in some places 
to the thickness of two or three inches. 

" The pancreas was throughout of a deep and dull red colour, which con- 
trasted very remarkably with the bloodless condition of other parts. It was 
firm to the feel externally; and when an incision was made into it, the divided 
lobules felt particularly firm and crisp. The texture was otherwise healthy. 
The part M^as left wrapped up in a cloth for nearly forty-eight hours after its 
removal from the body, the weather being then very cold. At the end of this 
time the hardness was gone, and the gland even appeared rather soft. 

" The spleen was rather large and turgid, livid externally, brownish-red in- 
ternally, and somewhat soft in texture. 

" The surface of the dura mater, covering the cerebral hemispheres, was 
lined in the neighbourhood of the falx, v/ith a very thin, soft, and almost muci- 
laginous layer of hght red tint; it could be scraped off with the handle of the 
knife, leaving the membrane of its natural appearance. There was slight serous 
infiltration of the pia mater. The blood-vessels of the brain were moderately 
full. The distention of the cellular membrane by serous effusion in this instance 
was analogous to the edematous swelling which often occurs round other parts 
when actively inflamed. 

" The pancreas is not imfrequently found after death, as it was in this case, 
preternaturally hard; and T suppose that the gland has been in this state in the 
numerous instances, in which we hear and read of its having been scirrhous. 
Although I do not know on what this hardness depends, I have never consi- 
dered it as a morbid condition; because it occurs in individuals who have died of 
other diseases, without any symptoms referable to the pancreas; because the 
structure of the part is perfectly healthy in all other respects, and because the 
hardness soon disappears after death, as it did on this occasion." 



Graham^s Treatise on Indigestion, 163 

The volume concludes with some patholog-ical and practical researches on 
uterine inflammation in puerperal women, by Robeiit Lee, M. D. We shall 
make this the subject of a special article in a future volume. 



XVII. ^ Treatise on Indigestion^ with Observations on some painful complaints 
originating in Indigestion^ as Tic Douloureux, Nervous Disorder, &c. By Tho- 
mas J. Graham, of the University of Glasgow, and of the Royal College of 
Surgeons, London, &c. First American, from the last London edition, re- 
vised and enlarged, with Notes and an Appendix, containing Observations rela- 
tive to the Modes of treating Dyspepsia, lately adopted and recommended by Dr. 
Avert, Mr. Halstead, and others. By an American Physician. Philadel- 
phia, Key & Mielke. Oct. pp. 206. 

The fruitful topic furnished by dyspeptic ailments, has, we think, been very 
judiciously treated in this volume of Dr. Graham's. The author's attention is not 
only directed to the best curative means, but to the exposition of the erroneous 
views that have been heretofore too generally inculcated in regard to certain 
affections often complicated with indigestion. He dwells particularly upon the 
two most prominent errors of the day, namely, the mistaking severe disorders 
of the stomach and intestinal canal, for disease of the liver, and the employment 
of large doses of mercurials for the cure of supposed liver complaints. He 
wishes to be understood as not inveighing against the proper use, but only 
against the abuse of mercurials, this last being an evil of magnitude in British 
practice, and we think there is reason to believe,, of still greater extent in that of 
America. 

Dr. Graham maintains that the maladies generally denominated ** liver and 
bilious complaints," proceeding from a supposed disordered condition of the 
liver, are not in any degree so frequent or so formidable as disorders of the ali- 
mentary canal. This he thinks sufficiently demonstrated by enlightened anato- 
mists whose numerous and close dissections were not instituted for the purpose 
of serving any particular views or doctrines. The investigations of Louis, Brous- 
sais, Andral, Abernethy, Howship, Marshall Hall, &c. are adduced in support 
of the correctness of his opinions. Whilst upon the subject of the fallacious 
character of the symptoms ordinarily reckoned the certain indications of disease 
in the liver, he gives us the following account of a late eminent British practi- 
tioner. 

"The late Dr. James Curry, (de mortuis nil nisi verum,) whose book on bi- 
liary concretions, together with his mode of practice, operated greatly in making 
diseased liver, and its supposed remedy, calomel, so very fashionable and fatal, 
was so wedded to his notions on this subject, that in his patients, invariably, 
the liver was considered the real source of all their ailments; and if, when la- 
bouring under stomachic irritation and disorder, they complained of pain in the 
left side, in the region of the stomach, he would endeavour to persuade them 
they were mistaken, and that it certainly was in the right! If he could not bring 
them over to this belief, it was his custom to say, * Ah, I shall brine- it there 
then!'" 

He subsequently informs us in another part of his treatise, that the same Dr. 
Curry was in the habit of putting his hand to his right side, and saying, he was 
assured there was a very small portion of liver left there. 



164 Bibliographical Notices. 

" Some might think," observes Dr. Graham, ** it was not wise in him to make 
so frequent a confession of this kind, since, if a man could live for years intole- 
rable health, (which was his case,) with only a very small portion of liver, and 
that probably in a state far from healthy, the conclusion g-enerally drawn from 
thence would be in no small degree unfavourable to the doctor's opinion, of the 
supreme importance of the healthful actions of this viscus, and of the absolute 
necessity of resorting to the free use of calomel in its derangements. How- 
ever, he was totally mistaken in his own case, for after death the liver was found 
to be quite sound! a circumstance not much in favour of his discriminating 
powers. Yet authors are not wanting, who speak of the practical success of 
this physician, attributing it to his superior acquaintance with hepatic disorders. 
To me, this success and discernment appear equally problematical." 

Dr. Graham distinguishes four different kinds of disorders of the digestive or- 
gans, each having its seat principally if not exclusively in a particular organ, 
though one species or variety seldom exists for any length of time, without pro- 
ducing an unfavourable change in the neighbouring parts. In one variety the 
stomach is the seat of the affection, in another, the small intestines are involved, 
in a third, there is faulty or deficient bihary secretion, whilst in the fourth, the 
large intestines are most affected, the derangement existing there being some- 
times the single cause of much local and general disturbance and distress. 
These, one and all, exert an immediate tendency to prevent the regular and 
perfect digestion and assimilation of the food. 

The discriminating symptoms of each of these varieties are pointed out with 
great distinctness, and after this we have the causes and treatment of indiges- 
tion successively dwelt upon with great ability. The views entertained by Dr. 
G. in relation to the pathology and treatment of indigestion differ essentially 
from those of most writers upon the subject, and We regret that we have not 
space in our bibliograph for even such a sketch as might gratify the general in- 
quirer. 

An ample appendix by the American editor adds some of the latest intelli- 
gence relative to dyspeptic complaints. The treatises particularly noticed are 
"the Dyspeptic's Monitor," ** Abercrombie on Diseases of the Stomach," &c. 
and Mr. Halstead's " New method of curing Dyspepsia." The productions of 
the two New York authorities. Dr. Avery and Mr. Halstead, are examined at 
considerable length, and the mechanical process constituting the new method 
of the latter, very accurately described. G. E. 



XVIII. Remarks on the History and Treatment of Delirium Tremems. By John 
Ware, M. D. Fellow of the Massachusetts Medical Society. Boston, 1831. 
pp. 61. 8vo. 

This interesting and well written treatise appears to have been originally 
published in the Transactions of the Massachusetts Medical Societj^, a work we 
have not had an, opportunity of seeing, but which is an important addition to 
our medical literature if its contents tally with the specimen before us. 

The subject of delirium tremens has necessarily attracted much attention 
from practitioners, and especially from such as are attached to public institu- 
tions, in which unfortunately there are but too frequently cases of this disease, and 
we offer no apology to our readers for again drawing their attention to it, being 



Ware on Delirium Tremens, 165 

fully convinced, to use the words of our author, ** that every subject in science, 
and more particularly, every subject in a science of a nature so peculiar as that 
of medicine, requires not only careful and repeated observation, but the care- 
ful and repeated observation of many individuals, in order to its thorough illus- 
tration." 

Dr. Ware has had ample opportunities of studying" the disease in question, 
as he states that his remarks are deduced from nearly one hundred cases, of 
which seventy-seven occurred in private practice, and the remainder in the 
Boston Alms-house i these were cases in which the disease was fully developed, 
as he does not include that far greater number of instances of incipient disease 
so common among drunkards. In his appreciation and treatment of these eases. 
Dr. Ware, we are glad to perceive, has followed the dictates of his own judg- 
ment, instead of blindly following one or the other of the favourite modes of 
cure. Most writers on this disease seem to think that although no two cases are 
precisely similar, that these differences need not lead to any corresponding 
difference in the mode of treating them ^ the result of Dr. Ware's observations has 
led him to a belief, that what are considered as the most peculiar and prominent 
symptoms, are not those which are really of the most importance, but that the 
practitioner is to be as much governed by the general situation of the patient, 
the character of his attack, and the state of his constitution, as in other diseases. 
As is well known to every one that has seen much of this complaint, the sus- 
ceptibility of drunkards to it is exceedingly various; in some it occurs on the 
slightest derangement of their functions, whilst in others the severest attacks of 
disease may take place without it making its appearance; nor does it appear to 
depend on the degree of indulgence in spirituous liquors, or the period of time 
during which they have been used. At the same time, as is remarked by Dr. 
Ware, those who become intemperate early in life are more subject to it than 
those who acquire the habit gradually, and have not used spirituous liquors to 
excess until they have reached maturity. 

Dr. Ware combats the common opinion, that delirium tremens is in most 
cases immediately occasioned by an abstinence from ardent spirits, and states, 
that in a large proportion of instances this had nothing to do with it. This 
agrees with our own experience; as we have seen numerous cases in which the 
disease appeared in the midst of the most excessive indulgence, as well as un- 
der the other circumstances to which he alludes. It may make its appearance 
suddenly, or be ushered in by a train of premonitory symptoms, of various de- 
grees of violence, and is pecuharly liable to occur in those drunkards who suf- 
fer from irritability of the stomach and frequent vomiting. We are sorry that 
our limits will not permit us to extract the entire account given by the author 
of the progress and. termination of an attack of delirium tremens; it is admira- 
bly and graphically drawn up, but is too long for insertion, and would lose its 
peculiar merits by condensation; we therefore pass to Dr. Ware's descriptions 
of the several circumstances, states of the system and disease, in coimexion 
with which the delirium makes its appearance. 1st. *' As the immediate conse- 
quence of a particular excess, or of a succession of excesses, in individuals not 
otherwise disposed to disease." This form is very common, and is vulgarly 
known under the name of the "horrors," and it is these cases, according to 
our author, that have led to the opinion that the disease was capable of being 

15* 



166 Bibliographical Notices. 

treated with equal success by the most opposite remedies; this inference, he 
thinks, unfounded, as it will equally subside of itself unaided by art. 2d. It oc- 
curs " as the consequence of habitual intemperance, without being occasioned 
by any particular or extraordinary excess." Cases of this kind are much more 
severe and dang-erous than the preceding, and are usually attended with more 
derangement of the gastric organs. 3d. Attacks of delirium tremens also occur 
" in connexion with other regularly-formed and well-marked diseases, or else 
as the consequence of injuries." In these cases it often comes on when the pa- 
tient is convalescent from the primary disease, or when he is only apparently 
convalescent. In all the above instances, the delirium assumes the form of a 
regular paroxysm, terminating in sleep; but this is not always the form it as- 
sumes; when supervening on other diseases, it may present many anomalies, 
both in its course and symptoms. 

Dr. Ware next gives a particular history of its principal symptoms; these are 
delirium, watchfulness, and tremor, of which the first is the most universally 
and constantly present; we cannot follow in detail this part of his treatise, for 
reasons already stated, but two or three of his remarks require to be noticed; 
thus, he justly observes, that an important distinction may be drawn between 
the watchfulness and tremors, as characteristics of the disease, " that the former 
occurs only in this affection, whilst the latter makes its appearance in all cases 
of sickness among drunkards, and is even common in many who are in their 
usual health." Besides these leading symptoms, others take place of more or 
less importance, as convulsions, some unnatural sensation in the head, variation 
in the pulse. "There is nothing peculiar in the state of the tongue; it is com- 
monly preternaturally clean, red, and tremulous; but this appearance is com- 
mon in diseases of drunkards." It is sometimes covered with a thin white coat, 
and more rarely thickly encrusted. ** In general, we may regard the tongue as 
rather indicating the general state of the system, then the state of the disease 
itself" We notice Dr. Ware's opinion on this point the more particularly as the 
foulness of the tongue is considered by the advocates of the emetic plan of 
treatment as one great indication for their use. The appetite usually fails; thirst 
is seldom excjsssive;i:he skin is generally soft and moist from the first, and to- 
wards the close of the disease it is bathed in sweat. 

"Morbid anatomy has thrown no light on the nature of that affection of the 
brain and nervous system, which gives rise to the peculiar symptoms of deli- 
rium tremens. Indeed, its history would rather lead us to expect, that these 
symptoms do not depend on any organic changes discoverable by dissection, 
but merely on a disturbance in their functions." In the treatment of these 
cases. Dr. Ware observes, that we should constantly keep in view: — "1st. By 
what measures may we prevent an attack of delirium tremens when it is 
threatened? 2d. By what measures may v/e arrest or alleviate the paroxysms, 
or carry the patient in safety through it." As regards the first of these inqui- 
ries, an attack, he says, is to be prevented by the judicious use of such gene- 
ral measures as will be spoken of in treating of its management. On the second 
question he dwells at some length, especially as to whether it is absolutely ne- 
cessary to procure sleep by the assistance of art; on the benefit of natural sleep 
there is no difference of opinion, but authors are not so unanimous as to the 
paramount importance of this state when artificially produced. Dr. Ware him- 



Ware on Delirium Tremens. 167 

self inclines to the belief, that this artificial sleep is not so necessary as has been 
supposed, and that even in many of those cases where it is said to have been 
beneficially induced, it did not actually take place sooner than it would have 
done in the natural course of the disease. *' I am satisfied, therefore, that in 
cases of delirium tremens, the patient, so far as the paroxysm alone is concern- 
ed, should be left to the resources of his own system, particularly that no at- 
tempt should be made to force sleep by any of the remedies which are usually 
supposed to have that tendency." We invite the attention of practitioners to 
Dr. Ware's arguments on this head, and although we do not agree with him as to 
the inefficacy of narcotics, we are ready to admit that he has staggered our be- 
lief in their absolute utility; and we have long agreed with him, that the ratio 
of success by the expectant plan has been nearly, if not fully as great as by the 
stimulant, or rather the narcotic. 

Dr. Ware's own mode of procedure may be thus summed up. When the at- 
tack is preceded by acute disease, the course which is most likely to relieve 
the original affection, is most likely to prevent the delirium, or at least to make 
it milder. In the treatment of the delirium itself, blood-letting is of great utility 
when properly timed, and employed with judgment, but is by no means to be 
indiscriminately resorted to in all cases. Local is more universal in its adaptation 
than general bleeding, and in fact may be beneficially employed in a majority 
of instances. Emetics are useful in all cases where the digestive organs are de- 
ranged, not to hasten the accession of sleep, as at first proposed, but for their 
effects on the general state of the system. No particular advantage arises from 
purging to any extent; it is, however, desirable that the bowels should be kept 
open. Bhsters, though reprobated by many practitioners, have been found use- 
ful in some cases. The general course to be pursued is thus detailed by Dr. 
Ware: — 

*' Where we are satisfied that the delirium is the immediate consequence of 
the excessive use of liquor in an individual previously in good health, no medi- 
cal treatment is necessary. If the patient be left to himself, and be debarred 
from ardent spirits, the attack subsides spontaneously. In the worst cases no 
medicines can be required beyond a dose of salts, and an infusion of valerian, 
of wormwood, or of hops. In those cases which are preceded by some general 
derangement of the system without any well-defined disease, our course is to 
be determined by the nature of the derangement, and the state of the constitu- 
tion. Where the patient is robust and vigorous, more particularly where in such 
a patient there has been convulsions, or severe pain in the head, general bleed- 
ing should be freely adopted, and is the most important remedy. In almost all 
cases, let the constitution be what it may, local bleeding may be regarded as 
beneficial, if not indispensable; and it is particularly called for, where there is 
dizziness, pain in the head, or much flushing of the countenance, with heat in 
the head or face. When the digestive organs have been long in a deranged 
state, especiallj^ when the stomach appears to be loaded with a mass of secre- 
tions which are offensive to it, and which excite it to ineffectual vomitings, a 
powerful emetic is of essential benefit. This may be followed by a cathartic of 
calomel, either combined with, or followed by some other article which will 
promote its full operation. It is afterwards only necessary to regulate the 
bowels by mild laxatives, unless some unusual symptoms arise which indicates 
a more active evacuating treatment." 

Dr. Ware is of opinion that the common practice of allowing spirituous 



168 Bibliographical Notices. 

liquors during" an attack, is incorrect. The diet should consist of nutritious 
liquids. As little restraint should be exercised over the patient as is consistent 
with propriety and safety; patients should never be intrusted, especially during 
the nig-ht, to females alone, as they frequently require to be restrained from 
acts of violence on themselves. 

The treatment after the paroxysm has nothing peculiar, and the convales- 
cence is generally rapid. 

It will be seen by the above sketch, that Dr. Ware's plan of treatment dif- 
fers from the generality of modes proposed, being however more aUied to the 
expectant than to the others. We recommend an attentive perusal of his paper 
to the advocates of the stimulant school, as showing that equal advantages may 
be obtained without the use of narcotics, &c. R. E. G. 



XIX. Treatise on the Excision of Diseased Joints. By James Stme, Surgeon, 8cc. 
p. 163. 8vo. Plates V. Edinburgh, 1831. 

The object of this work is to recommend the practice spoken of in the title, 
which seems to have been very successful, at least in Edinburgh, for out of se- 
venteen cases of excision of the elbow-joint performed there, only two have 
terminated fatally, of which, one the author believes would have died from any 
operation whatever, while in the other, the disease was found so extensive as 
to render excision almost impracticable. 

The considerations which give to this operation an advantage over that of 
ordinary amputation, are less ultimate hazard to the life of the patient and the 
preservation of the limb. 

"The advantages of amputation are, that it quickly, easily, and effectually 
removes the disease; but these are balanced by the serious objection of its de- 
priving the^patient of a limb; and it may be added, that, though this ope- 
ration cannot now be regarded as attended with much danger, it is certainly 
not by any means free from it. To say nothing of the ordinary bad consequences 
of amputation, I must here particularly notice the risk of inflammation and sup- 
puration of the lungs, or other internal organs, which renders the result of am- 
putation for caries so unsatisfactory, especially in hospitals. Every one who has 
attended the Hotel-Dieu, must have remarked the frequency of death, or rather 
the rarity of recovery after the removal of limbs in such circumstances; and 
though the evil seldom goes to such an extent in other places, I am sure all 
practical surgeons must be familiar with it. It is also observed that adult patients 
who have suffered amputation for caries, often fall into bad health, and die of 
dropsy or some other chronic complaint within a year or two after the operation. 
These bad effects seem referable with most probability to the disturbance 
which is excited in the system by taking away a considerable part of the body; 
but, whatever be the true explanation of them, there can be no doubt as to the 
fact of their occurrence, which ought to be carefully remembered in making 
the comparison that is now attempted. 

The great recommendation of excision is, that it saves the patient's limb; and 
the benefits accruing to him from this are so important and conspicuous, that 
unless the objections which can be urged against it, should appear after mature 
consideration to be very serious indeed, we ought not to hesitate in giving it 
the preference. These objections so far as I have been able to ascertain, are 
the following: — Firsts The difficulty of the operation. Second, Its danger. 
Thirdt The useless condition of the limb in which it has been performed." 



Syme on Excision of Diseased Joints. 169 

Our author asserts with much confidence, founded on his experience, that 
even in old cases of diseased joints, when the sinuses are numerous, the texture 
of the surrounding" parts much vitiated by suppuration and the effusion of se- 
rum, tog-ether with a synovial membrane converted into a thick, gelatinous sub- 
stance, yet the operation is effectual. 

He remarks, that — 

" With reg-ard to the cartilag-e, it might be expected that no harm could re- 
sult from leaving any part of it that remained sound; but here too the judg- 
ment of theory is reversed by experience, since it has been found that when 
any portion of the articulating surface was left, the disease required a subsequent 
operation. The cause of this is probably to be referred, not so much to any 
morbid process in the cartilage itself, as in the synovial membrane lining it, and 
in the spongy bone immediately subjacent, which has its tendency to morbid 
action excited by the injury sustained in its neighbourhood. The operation, 
therefore, essentially requires the removal of the whole cartilaginous surface. 

Lastly, as to the bone, one not acquainted with the pathology of the osseous 
tissue, who examined the bones of carious joints after maceration, might be apt 
to suppose that the diseased part could not be removed without sacrificing so 
large a portion of the whole as to render it useless and unworthy of preserva- 
tion." Mr. S. gives a representation in his work of an elbow-joint, which he 
amputated before adopting the plan of treatment now under consideration. 
In this the bones are much increased in thickness to a considerable distance 
from the articulation, and their surface in the whole of this extent is covered 
with irregular warty excrescences, which give it a rough tubercular ap- 
pearance. *' When these tubercles are examined more particularly, they are 
found to consist of a compact osseous substance, which is smooth on the sur- 
face, and perforated with numerous apertures for the transmission of blood- 
vessels. This is new bone, and perfectly healthy in its actions; it resembles in all 
respects the callus, or new osseous substance, which effects the reparation of 
fractures, and is thrown out in consequence of the irritation of the disease. 
The truly morbid or carious portion of the bone occupy merely the articulating 
surfaces. The external shell of the spongy bone is removed by the disease, and 
the cancelli are exposed to view, presenting a rough surface composed of rigid 
plates and spiculse, which are white and more brittle than usual, so as to seem 
as if they had been subjected to the action of fire. The depth to which the 
bone is thus affected varies considerably, according to the origin of the disease. 
When the morbid action commences in the synovial membrane or cartilage, it 
is generally superficial: but when the inflammation is primarily seated in the 
substance of the spongy bone, as in the third kind of white swelling which has 
been mentioned, then, as has been already stated, the substance of the bone is 
more deeply affected, being often excavated into a hollow, which is carious 
over the whole of its surface. The extent of this cavity seldom, or rather never 
exceeds the bounds of the epiphyses, except sometimes in young subjects, 
where the bone has been widely altered by scrofulous action, previous to suf- 
fering the inflammation which more immediately occasions the caries. From 
not distinguishing between the truly diseased bone and that effused in conse- 
quence of its irritation, it appears that a much larger portion has been taken 
away in some of the cases of excision hitherto pubhshed than there was any 
occasion for. Less than a half of the portions of the humerus and femur which 
were removed by Moreau and Crampton, I should certainly think, so far as can 
be judged from the evidence of their drawings, would have been sufficient for 
the purpose, in which case it is plain the limbs would have been much less 
shortened and weakened, and the magnitude and consequent severity of the 
operation diminished. As already stated, the caries seldom goes beyond the 
epiphyses, which are all the part of the bone that the surgeon requires to 



170 Bibliographical Notices. 

remove except in the rare cases where the bone is found to be more exten- 
sively affected? and in these it will probably be most prudent to perform 
amputation." 

Mr. Syme considers that in regard to the hazard of this operation, it is much 
inferior to that from a wound inflicted on a sound joint, and that the effect of 
it is rather to allay than to increase irritation, for patients have been observed 
to sleep better the nig-ht after the operation, than for a long time previously. 

*'It has been said, that after the joint is cut out, the bones must either unite 
together, so as to render the limb rigid and unserviceable, or, if it remain move- 
able, the attachments of the muscles having been separated, it must be no less 
unfitted for use by its flaccidity and want of subjection to voluntary motion. 
With regard to the first of these events, I think it cannot be denied that anchy- 
losis of the shoulder or elbow, provided the other joints remained entire, so far 
from rendering the limb useless, would not prevent many of its usual actions, 
and certainly not to the extent of permitting it to be compared, in respect of 
utility, with an artificial substitute. But it has been ascertained by the sure de- 
cision of experience, that true anchylosis or osseous union does not occur ge- 
nerally or even frequently in these circumstances; indeed, I feel authorized to 
say, not without very great attention on the part both of the surgeon and pa- 
tient in favouring its accomplishment, particularly in preserving absolute rest; 
but when no such precautions are used, the union is established by means of a 
tough, flexible, ligamentous-like substance that permits the bones to be used 
with more or less freedom, according to the exercise which they are made to 
undergo during the process of healiug. And the voluntary motion, though at 
first impaired, or altogether lost, owing to the relaxation of the muscles, which 
is caused by the approximation of their attachments, necessarily resulting from 
the shortening of the bones, gradually returns, and ultimately becomes as 
strong as ever. What seems to occasion the greatest difficulty in conceiving the 
possibility of recovering voluntary power over the new joint, if joint it may be 
called, proceeds from inattention to the fact, that muscles or tendons, when 
cut aAvay from their attachments, fix themselves to the parts on which they 
come to rest. Thus the muscles of a stump adhere round the bone, so as 
to enable the patient to use it with force and freedom; and when amputation is 
performed through the tarsus, the tibialis aiiticus and extensors of the toes fix 
themselves so as to counteract the extensors of the heel. Independently of 
theorj^, however, we have here the more satisfactory assurance of positive facts; 
and the cases related below, will, I trust, be considered sufficient evidence to 
show that it is possible to save limbs by excision of diseased joints, nearly, if 
not altogether, as useful as before they suffered from disease. 

*' In addition to the arguments against excision which have now been consi- 
dered, it has also been objected that the operation affords no assurance against 
a return of the disease, but as this objection applies equally to amputation, it 
need not be taken into account." 

Mr. Syme recommends for this operation a long, narrow scalpel, which is to 
be thrust at once into the joint so as to open it freely; the parts covering the 
bones are then to be dissected up the proper distance, by keeping as near as 
possible to the bones, so as to leave the tendons and muscles. The bones are 
then to be sawed through with an amputating saw, which he thinks the most 
convenient instrument; it is, however, sometimes better to finish, the division 
of them with tlie bone pliers. The haemorrhage, though free in the beginning, 
seldom persists so as to require the application of ligatures, but occasionally the 
latter are indispensable. 



Syme on Excision of Diseased Joints. 171 

*'The next part of the process is to place the edges of the wound in con- 
tact and retain them together, which is best effected by the intei-rupted suture^ 
unless the integuments should be so very soft as to give way under the pres- 
sure of the threads, in which case compresses of lint must be used in their 
stead. It is always of most consequence to unite the edges of the transverse in- 
cision, if there is one, since, if they do not heal by the first intention, they are 
afterwards brought together with very great difficulty, and the broad cicatrix 
which results from their separation is very adverse to the mobility of the joint. 
Some compresses of lint ought to be applied over the flaps, and then the limb 
being placed in a proper position, that, namely, in which it will most frequent- 
ly be required after the cure is completed, it ought to be enveloped with a 
long roller, which affords the requisite support much better than splints or rigid 
cases of tin or pasteboard. 

** The constitutional disturbance, for the reasons already stated, is usually 
very slight, and requires nothing more than some gentle purgative or slight an- 
timonial, with spare diet and rest. The pain is usually severe for the first five 
or six hours, but then subsides, and seldom proves troublesome afterwards. The 
dressings ought to be changed ten or twelve hours after the operation, by 
which time the oozing of blood and serum will be at an end; and then also any 
inequality or gaping of the edges may be rectified by slips of sticking-plaster. 
Union hy the first intention sometimes takes place through nearly the whole 
line of incision, except where old sinuses exist in its course; more frequently 
the adhesion is only partial and the wound opens out more or less widely, ac- 
cording to the degree of local inflammation, and the distention caused by blood 
contained within its cavity. In the course of a few days, the discharge, which 
was at first copious and offensive, begins to diminish; all the clots of blood issue 
from the wound; the swelling subsides; and the favourable change is altogether 
so sudden and satisfactory, as to surprise those who are not accustomed to wit- 
ness tlie operation. 

*' During the cure, every means is to be employed either to keep the limb 
perfectly quiet, to favour anchylosis, or to exercise it in the degree and extent 
of mobility which will be required of it. The wound is generally very nearly 
healed in the course of a few weeks, but one or more sinuses continue to dis- 
charge for months or even a year or two. Small portions of bone also occa- 
sionally come away; but if the surgeon has done his duty in the first instance, 
he need not be under any apprehension on these accounts; and the patient will 
be too well pleased with being freed from the pain of his disease, and having 
regained the use of his limb, to feel annoyed by the trifling inconvenience 
which he thus experiences." 

After these general observations, Mr. Syme gives a narrative of the cases 
where he has applied successfully this operation to the shoulder, the elbow, 
the knee, and the foot, the details of which it is not necessary to introduce 
here. Some of the recoveries were certainly of the most gratifying kind, and 
highly honourable to the science of surgery. 

We present in extenso his methods of operating on some of the joints, as it 
would be difficult to give an abstract of them with justice to the author. 

In the case of the shoulder, he says — 

"I believe that the best way of bringing the bones completely within reach 
with least injury to the soft parts, is to make a perpendicular incision from 
the acromion through the middle of the deltoid, nearly to its attachment, 
and then another shorter one upwards and backwards from the lower extre- 
mity of the former so as to divide the external part of the muscle. The 
flap thus formed being dissected off, the joint will be brought into view, 
and the capsular ligament, if still remaining, having been divided, the finger of 
the surgeon may be passed round the head of the bone, so as to feel the attach- 



172 Bibliographical Notices. 

ments of the spinati and subscapular muscles, which can then be readily divided 
by introducing the scalpel first on the one side and then on the other. After 
this the elbow being pulled across the forepart of the chest, the head of the 
humerus will be protruded, and may then be easily sawn off while grasped in 
the operator's left hand. The subsequent part of the operation will be con- 
ducted on the principles already explained, and as it is of course desirable to 
preserve as much mobility as possible, no means should be used to restrain mo- 
tion further than are necessary for preventing irritation and displacement. The 
pedoralis major and latissimus dorsi tend to draw the extremity of the bone in- 
wards, but this may be easily prevented by placing a cusliion in the axilla." 

In the operation on the elbow, he recommends the patient lying with his face 
downwards, on a sofa or table. 

" It is always right to take away the whole of the sigmoid cavity of the ulna, 
which comprehends the olecranon and coronoid processes, together with the 
head of the radius and extremity of the humerus as high as its tuberosities. More 
than this, for the reason just mentioned, need not be removed; and a smaller 
portion would not include the whole of the cartilaginous surface, none of which, 
according to the general principle already explained, ought ever to be allowed 
to remain. 

" The easiest way of accomplishing this, is to remove the olecranon in the 
first place; then to cut the lateral ligaments of the joint, so as to free the ex- 
tremity of the humerus, and saw it off"; lastly, to detach, by means of cutting- 
pliers, the head of the radius, and the remaining part of the sigmoid cavity. 
The reason for not separating at once the whole of the ulna that requires to be 
removed is, that, in case it is divided below the insertion of the brachiseus in- 
ternus, its removal becomes extremely difficult- Having experienced this in- 
convenience in one of my first cases, I have since always proceeded as has just 
been described, and never found any difficulty in detaching the coronoid pro- 
cess after gaining the free space that was afforded by removing the olecranon. 

*' A simple longitudinal incision will not give sufficient access to the joint to 
allow of its excision, even in a sound state of the parts, much less when they 
are thickened and preternaturally adherent, as in cases of caries. An additional 
transverse cut was therefore proposed by Mr. Park, intersecting the other at 
right angles; but this plan labours under the double objection of splitting the 
triceps, and not permitting free exposure of the humerus. A method still 
more objectionable, on the ground of unnecessarily injuring the muscles, 
is to make a longitudinal incision, and two transverse ones at its extremities, 
so as to form two lateral flaps. By far the best plan that has yet been con- 
trived, is that of Moreau; and though it may appear at first sight com- 
plicated and destructive to the soft parts, it is really the easiest and least in- 
jurious that can be imagined." In making the transverse cut, which should 
be close above the olecranon, the ulner nerve is apt to be wounded or di- 
vided; and though the facts mentioned below make this injury appear of 
very little consequence, as there can be no advantage in inflicting it, the sur- 
geon ought to use the precaution of ascertaining the situation of the nerve be- 
fore introducing the knife. The thickening of the limb is sometimes not so 
great as to prevent the nerve from being felt, but more frequently its situation 
can be discovered only by recollecting its position relatively to the bones; it 
lies close to the inner edge of the olecranon, and will certainly be cut if the 
transverse incision is prolonged further th^n this towards the internal tuberosity 
of the humerus. The surgeon, therefore, ought to feel for the olecranon, and 
introduce his knife close to its upper surface, with the back turned towards its 
inner margin, but somewhat nearer its radial side. Having thrust the knife 
down into the joint, he ought to cut transversely, with a sawing motion, so as 
to insure the division of the tough tendinous parts, until he arrives at the radial 
tuberosity of the humerus. He may then make the longitudinal incisions, which 



Syme on Excision of Diseased Joints. 173 

should extend about an inch and a half upwards and downwards, without any 
danger whatever, as the oblique course of the nerve recedes from the line of 
division. Both flaps should be dissected previously to commencing' the excision 
of the bones, and it is thus rendered much easier than when the exposure is 
confined to the part that is to be first removed. The haemorrhage is generally pro- 
fuse immediately on the incisions being made, but soon diminishes, and seldom 
persists to such extent as to require the application of a ligature; on the princi- 
ple already stated, however, it is right to secure any vessel, however small, 
that threatens to continue to bleed. In those rare and perplexing cases, where 
the ulna is diseased below the coronoid process, and requires to be divided 
through its shaft, the interosseous artery is very apt to be divided, and must, of 
course, be tied. As to the humeral artery, it is always perfectly safe, being pro- 
tected from injury by the whole thickness of the brachialis internus. 

** There is a great variety in tlie difficulty which is experienced in perform- 
ing this operation in different cases. The adhesions are sometimes so general 
and so firm that no way can be made without the knife; while, at other times, 
the suppuration has, as it were, already dissected the bones, so that the sur- 
geon, after making his incisions, has little to do bat to apply his saw and pliers 
for their removal. When the ojieration is concluded, the edges of the wound 
are to be stitched together; the limb ought to be half bent, and a long roller 
appHed in the figure of eight to give it proper support." 

In the operation on the knee — 

" The patient being laid on his back, the surgeon should rapidly divide the 
integuments and other parts exterior to the joint, so as to open its cavity, and 
remove the patella. Having next cut the lateral ligaments, he may readily pro- 
trude the extremity of the femur, and saw off as much of it as seems necessary. 
He has lastly to take away the diseased part of the tibia, which can now be done 
very easily, by passing the knife round the head of the bone, so as to detach 
its connexions, and then sawing off a slice of the requisite thickness. 

" During this process, the popliteal vessels may seem to be in danger, but 
really are not so — as the insulation of the bones is not performed until the liga- 
ments which connect them together are divided, and no longer oppose their 
being separated from each other, so as to be more distant from the vessels. 
There is not much bleeding, but one or two of the articular branches may re- 
quire to be tied. After the operation, a great difficulty has been experienced 
in bringing the limb into a straight position, owing to the contracted state of 
the flexor muscles, which still prevent extension, notwithstanding the relaxa- 
tion that is afforded by shortening the bone. In this case, the surgeon must be 
satisfied with placing the limb on a double inclined plane, in as good a position 
as can be obtained by moderate force, exerted through the means of paste- 
board splints. In a few days it will be found that the tension gradually dimi- 
nishes, and before long allows the leg to be completely straightened. 

*' During the cure it does not seem proper to insure absolute rest, in order 
to obtain a true anchylosis or osseous union, since the very long bone that 
would thus be formed, besides being extremely inconvenient to the patient, by 
rendering the limb perfectly rigid, could not fail to expose it to a great risk of 
fracture, by affording long levers to forces acting at the extremities. A great 
degree of flexibility, on the other hand, would unfit the limb for support and pro- 
gressive motion, so that, while perfect immobility and free motion ought to be 
avoided, a slight degree of flexibility ought to be promoted. The chief diffi- 
culty of the cure consists in preventing the tendency to bend outwards, which 
is always strong, and, if not counteracted, most injurious to the appearance and 
usefulness of the limb. The best mode of opposing this distortion consists in 
the careful application of splints." 

We have thus presented to the reader some of the most valuable features in 
this publication; the operation recommended has been so seldom performed in 
this country, that though we cannot advocate the practice upon personal ex- 
perience, yet we think it worthy of candid consideration. 

No.XVIL— Nov. 1831. 16 



174 JBibliograpMcal Notices. 



XX. Practical Observations on Prolapsus of the Rectum. By Fiiedeiiick S almost, 
F. R. C. S. &c. &c. London, 1831. pp. 105, 8vo. Plates IV. 

Prolapsus of the rectum, notwithstanding* its frequent occurrence and painful 
character, has- not attracted the particular attention of the profession. This 
may have arisen, as is suggested by Mr. Salmon, not from a want of inclination on 
the part of practitioners to acquire a proper knowledge of the subject, but 
rather their inability to obtain it, owing to the meagre accounts of it usually 
presented in medical writings, and to the disinclination of patients to declare 
its existence till fully developed, thus precluding all opportunity of studying 
its different stages. We were therefore glad to see the announcement of the 
work whose title we have given, trusting that it would supply us with such in- 
formation on the subject, as would prevent our approaching this disease with 
distrust and uncertainty. In this expectation, we have not been disappointed, 
and Mr. Salmon is entitled to the thanks of the profession for the physiological 
manner in which he has considered the disease in question, grounding his ob- 
servations on the only true basis, practical experience. Something is even 
gained by his denominating the complaint what it in reality is — prolapsus of the 
rectum; and not prolapsus ani, a name which involves a contradiction of terms. 

As the work may not fall into the hands of many of our readers, we will give 
as full a view of the author's facts and opinions, as is compatible with our li- 
mits. He first gives a sketch of the healthy and morbid anatomy of the rec- 
tum. On the first, as he offers nothing new, we shall not dwell, except in 
noticing the following observation: — 

*« The external and internal coats are connected by cellular tissue. When the 
rectum has suffered from long-continued irritation this uniting medium is so much 
increased, that in extreme instances it forms an artificial coat between the mu- 
cous and muscular portions of the bowel. From the same causes, the internal 
coat of the intestine participating in the irritation, becomes thickened and 
elongated, so that its folds, anatomically denominated the columns of the rec^ 
tum, are materially increased in size. Now both these are usually produced 
before any extensive prolapsus of the bowel occurs." 

The mucous coat of the rectum, which is continuous with the fine skin 
lining the sphincter, is also more or less elongated in the early stages of pro- 
lapsus, sometimes only protruded on the discharge of the faeces, whilst at others 
it forms pendulous flaps, which become larger when they are irritated. As the 
disease advances, the natural appearance of the parts is wholly changed, and 
an irregular fleshy mass makes its appearance on any exertion of the abdomi- 
nal muscles. In this state, its appearance varies very much, both in form and 
colour, giving rise in some cases to a suspicion of cancer. 

The author divides the causes of prolapsus into constitutional and local; 
among the most common of the first of which is costiveness. The presence of 
accumulations of fecal matter in the rectum, not only is a cause of general and 
local irritation, but also by the distention they cause, induce a permanent 
elongation of its mucous membrane. Prolapsus may also arise from the op- 
posite state; the violent straining attendant on diarrhoea, not only causes a dis- 
tention of the sanguineous vessels of the intestines, but also induces chronic 
inflammation, and the thickening already spoken of. This disease may also arise 



Salmon on Prolapsus of the Rectum. 175 

from a derang-ed condition of the liver, and such cases are distinguishable by the 
colour of the prolapsus, which presents a bluish appearance from the engorge- 
ment of the minute hsemorrhoidal vessels. It may likewise be caused by indi- 
gestion, general debility, want of due attention to diet, &c. A very fruitful 
source of it, is a sedentary employment, hence its prevalence among females. 
It may also be brought on by a protracted and violent action of the abdominal 
muscles, as hard riding, parturition, &c. The local causes are, any circumstance 
preventing a free evacuation of the rectum, as piles, calculus, &c..; in children, 
worms are a common source of it. It may result from local injury to the bowel; 
from a morbid condition of the external sphincter ani; but the most usual 
cause of the disease is a contraction of the gut itself, which not only offers a 
permanent obstacle to the action of the intestine, but also prevents a free re- 
ttirn of blood through the part. Mr. Salmon next details the symptoms of this 
distressing complaint, and observes, although when in its confirmed state, they 
are clear and decisive, it often happens that they are so obscure at first, that 
the patient is not aware of the existence of the disease, attributing his diffi- 
culty in passing his evacuations to costiveness, and hence resorting to purga- 
tives; but this difficulty soon increases, and a sensation of distention just 
■\yithin the sphincter is experienced, discharges of blood now begin to make their 
appearance, and the disease is pronounced to be piles. At this time the patient 
also experiences pain in one or both hips, extending to the lower extremities, 
being particularly felt across the insteps, or in the calves of the legs. Before 
long, any attempt to evacuate the bowels, causes acute pain at the sphincter, 
with a sensation of something protruding, which retires on the cessation of the 
effort, and excites butlittle attention, till a portion of it becomes strangulated, and 
requires to be returned. In this state patients will go on for a great length of 
time before applying for medical assistance. After this the disease rapidly in- 
creases, and becomes excessively painful, and from its magnitude prevents the 
passage of the smallest evacuation without acute agony; and at last will descend 
on the slightest exertion, or even spontaneously, so that it is obliged to be re- 
tained within the sphincter by mechanical means. 

In the succeeding chapter the author takes up the treatment, and observes, 
that our first object should be to remove or mitigate the disease without a re- 
currence to an operation. Our success in this, however, will depend on the 
cause of the affection. If it has arisen from general causes, and is unconnected 
with any local derangement, the cure may often be effected by very simple 
means. Thus, the patient must be interdicted from any recreation or employ- 
ment likely to have occasioned the disease. Attention must also be paid to the 
condition of the stomach and bowels, and care taken that the quantity of food 
be moderate, and that none of an astringent nature be allowed, especially rice, 
high-seasoned meats, crude vegetables or fruits, as well as fermented liquors, 
and excessive indulgence in wine. In the management of the bowels, although 
costiveness should be scrupulously guarded against, no medicine ought to be ad' 
ministered of an irritating character, as the drastics, and more especially aloes; 
on the contrary, the purgatives chosen should be of the mildest character, and 
given in the smallest possible dose. The state of the liver is not to be over- 
looked, as in most cases of chronic prolapsus of adults, the functions of this 
viscus are more or less at fault; hence this organ must be restored to a normal 



1 76 Bibliographical Notices. 

condition by venesection or local blood-letting, and alterative doses of mercuiy. 
If the digestive functions are impaired, we may recur to some of the bitters com- 
bined with small doses of the alkalies. Daily exercise on foot or in a carriage is 
indispensable; when the latter is used, a seat of cane net-work, or an air 
cushion should be used, as it is of the utmost consequence to prevent any deter- 
mination of blood to the parts. As regards the local treatment, Mr. Salmon 
gives ample instructions, which we shall cursoril}^ notice. He is highly in favour 
of a proper use of enemata, but at the same time protests against the habit of em- 
ploying large injections on every trifling occasion: he says that the quantity 
should not exceed a pint, and even half this will often suffice. He prefers the 
gum elastic bottle and pipe to any other instrument for this purpose. Astrin- 
gent washes are useful in the first stages. Leeches to the anus are very bene- 
ficial, especially where the liver is disordered. The use of opiate suppositories, 
or sedative lotions to the orifice, ai'e also very useful in relieving the irritability 
of the sphincter. In the ulcerative stage, chloride of lime, in the proportion of 
half a drachm to a pint of water, a third of which is to be used night and morning 
as an enema, will lessen local irritation and correct the offensive odour of the 
discharge. Bandages are often required as a local support, where the removal 
of the tumour is contraindicated. The most essential point is to ascertain whether 
there is not a diminution in the calibre of the intestine, as if this exists, any at- 
tempt to cure the prolapsus will be useless. This contraction does not always 
exist near the orifice; in fact, prolapsus can scarcely take place when the latter 
is the case, as there will not be sufficient mucous membrane below the stricture 
to be protruded. The state of the rectum ought to be examined in every 
case of prolapsus, as this examination can never be productive of any possible 
injury. 

Mr. Salmon next enters on the consideration of the various operations requir- 
ed in the cure of prolapsus, the first of which he notices Id division of the 
sphincter; this must be resorted to when the muscle is so strong as to become 
a permanent obstacle to the function of the bowel. This state of things, it is 
true, may sometimes be remedied by the use of the bougie or the plug, but per- 
manent relief is only to be expected from a division of the sphincter. This 
may be done either by a simple incision, or by the removal of a triangular por- 
tion of it. Where the muscle is narrow the first is sufficient, but when it is 
very broad, the latter should be had recourse to. 

To ensure the success of the operation, we must be cautious not to allow the 
wound to heal from its edges, and in order to prevent any contraction after its 
cicatrization, a plug should be occasionally introduced. We cannot give the 
mode of operating as the author refers to plates of instruments invented by him 
for the purpose. The next surgical operation spoken of, is the removal of the 
tumour. For this purpose he infinitely prefers excision to the use of ligatures, 
as being more certain and less painful, the only objection to it being the danger 
of hsemorrhage, and this he thinks he is able to obviate by a plan devised by 
himself, which he says has been eminently successful. It is as follows — the 
patient being placed in a proper position, one or more long pins are to be pass- 
ed from above downwards transversely through the basis of the tumour, to pre- 
vent the return of the intestine after the operation is performed. The promi- 
nent parts of the tumour are then to be seized by a hook or forceps and drawn 



Higginbottom on the use of Nitrate of Silver, 111 

gently to the opposite side, and with one stroke of the scissors, the part is to be 
removed as deep as the division between the mucous and muscular coats; the 
latter must be left entire, or there will ensue a permanent difficulty of evacuat- 
ing* the bowels; all the protruding portions are to be thus taken off. Any ma. 
terial bleeding is to be checked by cold, &c. The pins are to be left for an 
hour or two, to permit the blood to coagulate in the extremities of the divided 
vessels, before the bowel is restored to its natural situation. When they are 
removed, the rectum is to be returned within the sphincter in the gentlest man- 
ner. The after treatment is perfect rest, liquid and rigid diet, &c. The reco- 
very is generally rapid, not requiring more than a week or ten days. Some- 
times, however, a ligature is obliged to be adopted; this should be of the finest 
silk, and should be pasged as is recommended by Dr. Roussean, of this city, in 
cases of haemorrhoids, through the tumour, so as to divide it into two or more 
parts. The ligature is much more apt to create local and constitutional mis- 
chief than is caused by excision, and is not as likely to give permanent relief. 

Mr. Salmon next makes some observations on that common disease, the ^ro- 
ddentia recti of infants. This is to be combated by astringent lotions and a 
proper bandage, and care taken to prevent costiveness, though the author with 
great truth, reprehends in the strongest manner the prevailing custom of purg- 
ing children on every occasion. This plan will not always relieve the prolapsus, 
as it may be occasioned by worms, which are to be expelled by the usual 
means. Mr. Salmon speaks favourably of injections of spirits of turpentine. 

A number of cases illustrative of the different forms of the disease are re- 
lated. R. E. G. 



XXI. An Essay on the use of Nitrate of Silver, in the cure of Inflammations, 
Wounds, and Ulcers. By Joaisr Higginbottom, Nottingham, Member of the 
Royal College of Surgeons of London. Second edition, much improved 
and enlarged. London, 1829. pp. 204. 8vo. 

The observations of Mr. Higginbottom respecting the therapeutic properties 
of nitrate of silver, are not only exceedingly interesting, but also possess, in 
several respects, the merit of novelty, and we shall therefore lay a pretty full 
account of them before our readers. We have had ourselves little experi- 
ence with the remedy employed in the mode recommended by our author, 
his essay, by some accident, never having reached us until a few weeks since, 
but are disposed however to place much confidence in the facts related by 
Mr. H., his experiments having been extensive, and apparently conducted in a 
proper spirit; and although something must of course be allowed for the zeal 
and enthusiasm of a discoverer, and Mr. H. appears to consider the nitrate of 
silver as a real panacea, still little doubt can be entertained but that it is a valu- 
able remedy in many local diseases in the treatment of which it had not been 
previously used, or had been improperly applied. 

Mr. H. protests at the very commencement of his work against the applica- 
tion of the term caustic to the nitrate of silver, since he says instead of destroy- 
ing, it frequently preserves parts which would inevitably slough except for the 
extraordinary preservative powers of this remedy. The principle then upon 
which Mr. H. sets out, is that nitrate of silver possess the property o^ subduing 

16* 



1 73 Bibliographical Notices. 

external inflanimationj and to effect this in some cases, it is sufficient merely to 
blacken the cuticle; in others it is necessary to induce a degree of vesication, 
which is however less irritable than that caused by cantharides, and in others 
to produce an adherent eschar. As to the modus operandi of the remedy, the 
author affords us but little lig"ht; his object, however, he states is simply to as- 
certain and state practical facts, and in this we shall follow him. 

When it is desired to produce vesication with the nitrate, the part must be 
first washed with soap and water, and dried; then again moistened, and a long 
stick of nitrate of silver be passed a few times over, not only every part of the 
inflamed skin, but also the surrounding healthy skin to the extent of an inch or 
more beyond it, in severe cases. The part is to be exposed to the air to dry, 
and is to be kept cool. In twenty -four hours, if the nitrate of silver has been 
properly applied, it will be frequently observed that the inflammation has sub- 
sided, and its progress checked; but if there be any inflamed spot left untouch- 
ed, the patient will complain of it. To every such spot the nitrate of silver 
must be applied. At this period there is usually a little vesication. On the 
third day there is generally more vesication and less swelling, and the patient 
complains of a little pain, as that of a blister; but the part on pressure has a 
puffy feeling, and is found to be quite free from inflammation. On the fourth 
day the vesications begin to disappear, the exuded fluid drying in crusts, which 
should be allowed to drop off spontaneously. On the fifth day these crusts se- 
parate, leaving the subjacent parts free from soreness and inflammation. It is 
sometimes a number of days before the whole of these crusts peel off, but it is 
best to leave them undisturbed. 

It is not, however, as a remedy in external inflammation alone, that Mr. H. ex- 
tols the nitrate of silver; he states in general terms that it is equally useful as a 
means of inducing tlie healing process or adhesive inflammation, in recent 
wounds, whether incised, punctured, or bruised. In incised wounds he says 
that union by the first intention is frequently secured by the application of the 
nitrate of silver on the surrounding cuticle — in punctured wounds union is pro- 
moted, and suppuration prevented— in bruised wounds, the action of the parts 
is so modified that their texture is often preserved unbroken, and sloughing 
which would otherwise inevitably have taken place, obviated. In neglected 
punctured wounds, attended by ulceration, pain, swelling, and fungous growths, 
and in cases in which there would have been destruction of the parts, as in 
deep-seated inflammation of the finger, the nitrate of silver has a most decided 
effect in checking the inflammation, in preventing that desti'uction of parts, 
and in inducing the healing process. In ulcers which are rapidly spreading, 
attended with severe and extensive inflammation, this remedy has frequently 
an immediate effect in subduing the inflammation and in inducing the healing 
process. In those cases of inveterate and obstinate ulcers of the legs which 
have been for years unhealed, attended by sleepless nights and painful days, 
the nitrate of silver, applied under peculiar regulations, has extraordinary 
powers in relieving the pain and inducing sleep, even from the first time of its 
application; and eventually in healing the ulcers themselves, and effecting a 
more firm and durable cicatrix than any other mode of treatment. 

For the attainment of these various objects, Mr. H. applies the nitrate of sil- 
ver in three different modes; 1st, to form an adherent eschar; 2d, when this is 



Higginbottom on the use of Nitrate of Silver. 179 

impracticable to produce an unadherent eschar; and 3d, when neither of these 
can be eifected, the use of the nitrate is combined with that of an emolUent 
poultice. 

The remedy is employed in the first method indicated, upon the principle 
that wounds and ulcers infallibly heal, whenever an eschar made over their 
surface, can be preserved adherent. 

" To the surface of the wound the eschar supplies a complete protection and 
defence, and allows the healing process to go on underneath, uninterruptedly 
and undisturbed. It renders all applications, such as plasters, totally vmneces- 
sary, as well as the repeated dressings, to which recourse is usually had in such 
cases; and it at once removes the soreness necessarily attendant on an ulcerated 
surface, being exposed to the open air. In many cases, too, in which the pa- 
tients are usually rendered incapable of following their wonted avocations, this 
mode of treatment saves them from an inconvenience which is to some of no 
trifling nature," 

Mr. H. lays great stress upon the importance of preserving the eschar adhe- 
rent, and avoiding all causes which might detach its edges. To secure this 
adherence more effectually, he protects the eschar by covering it with gold- 
beater's skin. It is applied by simply moistening the skin surrounding the 
wound by a drop of water, and then applying the gold-beater's skin over it and 
the eschar, to which it soon adheres firmly, and from which it may be at any 
time removed by again moistening it for a moment with water. 

*'In this manner, in cases in which there would be much and long-continued 
irritability and pain, as in superficial wounds along the skin, all this suffering-, 
and its consequence in disabling the patient, are completely avoided. A blush 
of inflammation forms around the eschar, but this gradually subsides without 
any disagreeable consequences, and the inflammation which would otherwise 
have been set up, is entirely prevented by the due formation of the eschar. In 
my earlier experiments I observed this fact; but since that time I have always 
applied the nitrate of silver on the surrounding skin, and beyond any inflam- 
mation which might be present, or which might supervene." 

The advantage of healing by eschar, over that by scabbing, as employed by 
John Hunter,* Mr. H. asserts to be very decided, and that he has found by 
comparative trials, that whilst the scab is irritable and painful, and surrounded 
by a ring of inflammation, the adherent eschar becomes totally free from pain 
and inflammation, and that whilst the scab remains attended by inflammation 
and unhealed, the eschar is gradually separating, leaving the surface under- 
neatfi completely cicatrized; finally, that the plan of healing by eschar is infi- 
nitely more certain, and more speedy, than that by scabbing. We can say 
nothing of this from our own experience; but it appears to us that tlie nitrate of 
silver must act in such case principally by coagulating the discharges from 
the wound, and thus securing the formation of a crust, which unassisted nature 
does not always effect; and no one can for an instant doubt the superiority of 
this method over that employed previous to the time of John Hunter, viz. the 
application of balsams and a farrago of stimulants. 

In recent injuries, and in very small ulcers, attended by little inflammation, 
the eschar is generally adherent; in other cases, it is too apt to be unadherent, 

* See his work on the Blood, 8iC. 



180 Bibliographical Notices. 

arising- from the formation of pus, or of a scab underneath. If pus forms, ren- 
dering' the eschar unadherent, which may be determined in the space of twen- 
ty-four hours, a small incision is to be made into the centre of the scab, with 
any sharp-pointed instrument, the fluid g-ently pressed out, and the nitrate of 
silver then applied to the orifice thus made. The same plan is to be adopted 
if the fluid ooze out at the edge of the eschar; it is to be fully evacuated by 
pressure, and the orifice is to be touched with the nitrate of silver. If the 
eschar be very large, and there are several cavities with pus, it may be neces- 
sary sometimes to make several small incisions in an eschar, but the healing 
process goes on best when the orifice thus made is in the centre of the eschar. 
In this manner, the eschar is occasionally rendered adherent; but more fre- 
quently the fluid requires to be repeatedly evacuated, and this should be done 
once a day, taking care that the eschar be not needlessly separated by allowing 
the fluid to accumulate. If the eschar be accidentally separated before the 
ulcer is healed, Mr. H. advises the nitrate of silver to be applied anew. At 
length the eschar becomes adherent, and in due time it peels off", leaving the 
surface healed. 

When the purulent matter is allowed to remain too long under the eschar 
without being evacuated, a scab forms underneath the eschar, this is attended 
with pain and inflammation, the eschar does not separate but remains long over 
the sore, and there is no appearance of healing. In this case, the whole must 
be removed by the application of a cold poultice for two or three days, which 
removes the eschar and allows the inflammation to subside, after which the ni- 
trate of silver must be reappUed. The gold-beater's skin is even more neces- 
sary, as a protection to the unadherent than to the adherent eschar, the former 
being more liable to be torn off" than the latter. 

Mr. H. does not recommend this treatment in all cases indiscriminately; on 
the contrary, he says that it is improper to employ the nitrate of silver, with a 
view of healing by eschar, in large ulcers, or wounds which do not admit of the 
formation of a complete eschar, or where the ulcer or wound is so situated as 
to render it impossible that the eschar should remain undisturbed, as between 
the toes, unless, indeed, the patient be confined to bed. 

In such cases Mr. H. recommends the application of the nitrate of silver, and 
then a poultice, and this from day to day according to circumstances, until at 
length, by the subsidence of the inflammation, and the cicatrization of the ul- 
cerated surface, the case may admit of the formation of an adherent eschar, and 
of the final healing of the ulcer. This plan he says he has found particularly 
useful in neglected punctured wounds attended by ulceration, pain and swell- 
ing, recently-opened abscesses, and in neglected deep-seated inflammations of 
the fingers. In these cases, he says, it is not only necessary to apply the nitrate 
of silver to the surface of the sore, but in every cavity or orifice which maybe 
formed by the disease, and also on the surrounding inflamed skin, repeating it 
as may be necessary. By this mode the pain and swelling are much subdued, 
and a free issue is secured for the secreted fluid, and Mr. H. has never seen 
the original inflammation increased by it. 

Mr. H. next exemplifies more particularly the beneficial eflTects of the remedy 
in several forms of external inflammation, in punctured and bruised wounds, 
ulcers, and lastly in burns and scalds. The external inflammations to which Mr. 



Higginbottom on the use of Nitrate of Silver, 181 

H. considers the nitrate of silver applicable are, phlegmon, whitlow, erysipe- 
las, and inflammation of the absorbents. 

In slight cases of whitlow, the application of nitrate of silver over the inflam- 
ed part will often prevent suppuration, but when this has already taken place, 
the abscess should be freely opened, the nitrate of silver applied well within 
the cavity, and the part then enveloped in the cold poultice and lotion. When 
the inflammation returns, the application must be repeated, but this is said sel- 
dom to occur. 

In slight cases of erysipelas of the face, Mr. H. resorts first to every active 
constitutional means of cure, and if these fail he then has recourse to the nitrate 
of silver rubbed over the moist skin, in the mode already described, and always 
it is stated with the result of subduing the cutaneous inflammation, alleviating 
the pain and heat, preventing sloughing, and relieving the constitutional 
symptoms. General antiphlogistic measures are, however, to be continued. 

In inflammation of the absorbents, Mr. H. applies the nitrate of silver to the 
ulcer or wound in which it originates, and slightly over the surrounding inflam- 
mation, along the course of the inflamed absorbents, and on the surrounding 
skin wherever there is any swelling. 

In recent punctured wounds, Mr. H. directs the orifice to be first examined, 
and if there be any loose portion of skin closing this orifice, it is to be removed 
by a pair of sharp-pointed scissors, or by a lancet: the puncture and surround- 
ing skin are then to be moistened with a little water, and the nitrate of silver 
is to be applied within the puncture until some pain be experienced, and rather 
lightly, so as not to occasion vesication, to the skin, for an inch round the 
puncture; and to a greater extent even, if the swelling exceeds that space: the 
part is then to be exposed to the air. It does not appear necessary to apply 
the nitrate of silver deep in the pimcturf^-, and it would o^rasion unnecessary 
irritation, in this manner, says Mr. H. it is astonishing how completely the 
terrible effects of a punctured wound are prevented. The eschar, indeed, fre- 
quently remains adherent, and the case requires no further attention. 

*^At a later period after the accident," he continues, "when the puncture 
has been neglected, some degree of inflammation is usually present, the orifice 
is nearly closed with the swelling, and a little pus, or fluid, is formed within: a 
slight pressure will evacuate this fluid. The nitrate of silver may then be ap- 
plied within the puncture, and over the surrounding skin beyond the inflam- 
mation, and must be allowed to dry. In this manner we frequently succeed in 
forming an adherent eschar, and in subduing all the inflammation. If there be 
any vesication, it may be simply left to nature: the fluid is soon absorbed or 
evaporated. 

" If there be reason to suppose that an abscess has formed deeply, it must be 
opened freely by a lancet, and the nitrate of silver is then to be applied within 
the cavity; a poultice of bread and water, and cold water as a lotion, are then 
to be applied over the whole. The application may be repeated every second 
or third day^ if the swelling or inflammation require it, and the cold poultice 
may be renewed every eight hours. I have several times applied the nitrate of 
silver over an inflamed surface, in cases where 1 was not aware that suppura- 
tion had taken place. Even in these instances an immediate check is given to 
the surrounding inflammation, and rehef to the pain; but in two or three days 
there is an increase of swelling, attended by some pain, which is not usual, ex- 
cept when there is matter, or some e5trap?Q\J§ body, underTipath. t" theso 



182 Bibliographical Notices. 

cases, I make a free incision with the lancet, and apply the nitrate of silver, and 
a cold poultice. 

**In cases of puncture, where the orifice is healed, and where an erysipela- 
tous inflammation is spreading", attended with swelling", I have applied the ni- 
trate of silver freely over and beyond the inflamed parts, to form an eschar; and 
I have had the satisfaction of finding- that the inflammation has been arrested 
in its progress, and has shortly subsided. 

" This mode of treatment is particularly useful in cases of punctured and la- 
cerated wounds from various instruments, such as needles, nails, hooks, bayo- 
nets, saws, &c. and in the bites of animals, in inflamed leech bites, in the stings 
of insects, 8cc. 

" The dreadful effects of punctures from needles, scratches from bones, of 
wounds received in dissection, and of other similar injuries, are often totally 
prevented by these modes of treatment. I have for the last seven years had 
frequent opportunities of trying- them in these cases, and have the most perfect 
confidence in their success. 

" In considerable punctured wounds, where an adherent eschar cannot be 
formed, the nitrate of silver may be applied to the lips of the wound, and over 
the surrounding- skin for several inches, so as not to induce vesication, and the 
edg-es of the wound may be brought together by sticking- plaster, as in healing- 
by the first intention. This mode of proceeding prevents the excess of inflam- 
mation and consequent suppuration, and the wounds have healed nearly as by 
the first intention." 

In some cases where the common mode of pressure by sponge and adhesive* 
plaster cannot be used to stop the bleeding of leech-bites, Mr. H. says it may 
be effectually stopped by the firm application of the point of a stick of nitrate 
of silver within the little orifice, continued for a short time. Mr. H. also states 
that this application to leech-bites, as soon as they have done bleeding, will 
cause an adherent eschar, and prevent that irritation and erythematous swelling 
to which some patients are subject. Where there is great inflammation also, 
several days after the application of leeches, it is quickly snabdued by the ni- 
trate of silver, and irritable sores following the application of leeches, heal rea- 
dily by eschar. 

In the treatment of bruised wounds, \lv, H. urges the early application of the 
nitrate of silver, and states in bruises of the skin he has in every instance ef- 
fected a cure by the adherent eschar, if this application was made early, unless 
the skin had been in an unhealthy and discoloured state from previous ulcera- 
tions, or in old persons in whom the skin was tender from exposure to the fire, 
or in whom there was considerable oedema. The difficulty, however, of forming 
an eschar is always increased by 'delay. When the patient applies too late after 
the accident to prevent the formation of a slough, and the slough itself is super- 
ficial, Mr. H. removes it with a pair of dissecting forceps and scissors, a prac- 
tice we conceive which would be " more honoured in the breach than in the 
observance." It certainly is not consonant with sound principles. 

In severe cases of bruise attended by inflammation and swelling, in which 
the suppurative stage had not commenced, the nitrate of silve'r must be applied 
on the bruised, swelled, and inflamed parts, so as to induce an adherent eschar, 
which is to be exposed to dry. In those cases where a recent bruised wound is 
too considerable to heal by eschar, the nitrate of silver should first be applied on 
the surrounding skin for several inches, so as not to induce vesication, and over 
the wound which cannot be covered by the skin: the skin is then to be brought 



Higginbottom on the use of Nitrate of Silver. 183 

as nearly into apposition as may be by means of common adhesive plaster,, 
without any intervening" dressing-. The plaster will not irritate the skin or wound^ 
for they are protected by the eschar. By this method the wound will frequently 
be healed by the first intention. 

In the treatment of ordinary ulcers, Mr. H. does not recommend the mode of 
healing by eschar, the attention, discrimination, and experience required on 
the part of the surgeon, and the necessary care on that of the patient, render- 
ing it rather difficult. Except, therefore, in small ulcers, where there is no in- 
flammation, but little discharge, and the parts not exposed to much friction or 
motion, Mr. H. has abandoned the practice. In large ulcers^ attended with in- 
flammation, he has, however, adopted another plan, which he states to be far 
more successful, and to require very little attention on the part either of the 
surgeon or patient. 

"If there be swelling or oedema, I direct the patient to take a dose of open-^ 
ing medicine, to apply a common poultice of bread and water over the ulcer, 
and to keep in bed for four and twenty hours. The inflamed parts must be 
washed with soap and water, and wiped dry. They are then to be moistened 
with water, and a long stick of the nitrate of silver must be passed all over the 
inflamed and ulcerated surfaces, twice, and rather more freely on the ulcer it- 
self, and on the surrounding skin. Lint must then be put on the ulcer, and the 
whole of the inflamed and ulcerated parts must be covered with the neutral 
ointment,* spread on linen? a compress of five or six folds of fine linen is then 
to be applied over the ulcer, and a common roller, not too tight, to keep on 
the whole. The leg is to be examined on the fourth daj^, when it will be found 
that the inflammation is nearly, if not entirely gone, and the ulcer is in a heal- 
ing state. The nitrate of silver must then be applied on the whole of the ulcer, 
and once lightly over the skin immediately surrounding it, one or two inches 
in breadth; the lint and ointment are to be applied as before, and the bandage 
rather tighter. The case must be treated in this manner every third or fourth 
day, until the ulcer be healed. I would recommend wearing a calico roller for 
some time afterwards, till the leg has recovered its usual strength. The patient 
may v/alk about after the first or second application of the nitrate of silver." 

Mr. H. like most other surgeons, has experienced the difficulty of managing 
old ulcers of the legs, and found the insufficiency in most severe cases of even 
the much-approved plan of Mr. Baynton. Mr. H. was therefore led to try various 
modes of application of the nitrate of silver in these cases, and after many ex- 
periments he has finally adopted the following plan. 

** The first thing I direct my patient to do in such a case, is to apply a com- 
mon white bread and water poultice, to keep in bed for eighteen or twenty-four 
hours, to allow any swelling of the leg to subside, and to take a dose of open- 
ing medicine. The leg is after this to be washed well with soap and water, to 
free it from any oleaginous substance, or loose cuticle,- it is then to be wiped 
dry with a towel, the inflamed part is to be moistened with pure water, and 
the nitrate of silver is to be passed twice over it, and a little beyond it on the 
healthy skin; and then, more freely, to every part of the ulcer, and particularly 
the edges and immediately surrounding skin; a piece of lint is to be put over 

* The following is the formula for the ointment here alluded to by Mr. H. — 
R. Emplastri plumbi, Ifeiij.; Olei olivse, ibij.; Cretse ppt. ^xviij.; Aceti distil- 
lati, ifej. The acetic acid and chalk must be well mixed in a mortar, and the 
lead plaster and olive oil, previously slowly melted together, are to be added. 
The whole is then to be stirred together until cool. 



184 Bibliographical Notices. 

the ulcers, and linen spread thick with the neutral ointment, over the whole 
inflamed and ulcerated parts; a compress of linen, and a common cahco roller 
are to be applied in the last place, the latter not tight, but just so as to retain 
the dressings in their place. The patient is obliged to remain a few hours in 
bed, on account of the pain occasioned by the application of the nitfate of sil- 
ver; but after this has once subsided, he enjoys more relief than from any for- 
mer application, and sleeps soundly all night, for the first time perhaps for 
years. The dressings are to be taken off at the expiration of the fourth day, the 
inflammation is then found to have nearly subsided, and the ulcer is become 
more healthy in its appearance. If any of the plasters adhere, they may re- 
main until the next time of dressing; the applications to the ulcer itself are 
readily removed, as there is usually a free discharge of lymph from its sur- 
face. This discharge is to be simply removed by a little linen or tow; the ni- 
trate of silver is again to be applied all over the wound, on its edges, and the skin 
immediately surrounding it; and if any of the plaster be detached, and there be 
any inflamed part, slight sore, or excoriation, those parts are to be slightly 
touched with the nitrate of silver. About the expiration of three more days, the 
eschar is found to be detaching itself from the surface previously inflamed, and 
all the inflammation gone. The patient now makes no complaint, is free from 
pain, sleeps well every night, is able to follow his employment; there is gene- 
rally a free serous discharge from the ulcer, free from foetor. The nitrate of silver 
is again to be applied over the whole surface of the sore, its edges, and the ad- 
jacent skin. This plan has the effect of preventing any inflammation of the sur- 
rounding skin, or irritation on the surface of the ulcer itself. It is to be repeat- 
ed every third or fourth day, till the ulcer be healed. When the ulcer is near 
the ankle, deep, of long standing, and with hardened edges, and with enlarge- 
ment of the vena saphsena, and swelling of the foot, I have added, to the mode 
of treatment just described, the treatment by strapping, recommended by Mr. 
Baynton, and recently improved by Mr. Scott.* The latter gentlemen recom- 
mends the emplastrum plumbi, which is not so apt to irritate the skin; but 
where the nitrate of silver is used, the common adhesive plaster may be used 
without inconvenience. If any excoriation did arise from any cause, a slight ap- 
plication of the nitrate of silver would induce a firm eschar, and prevent any ill 
effect. I prefer that the adhesive plaster should be spread upon dimity, which 
is stronger, and gives more support than the calico." 

Mr. H.'s experience in the use of the nitrate of silver in burns and scalds has 
not been very extensive, yet as far as it has gone it appears satisfactory. He 
says that by slightly passing the nitrate of silver once over a burnt surface, the 
pain is increased for a short time, but then totally subsides, vesication appear- 
ing to be prevented; the black cuticle peels off in a few days, leaving the part 
well. In cases in which the cuticle has been removed, the nitrate of silver ap- 
plied on the surface induces an adherent eschar, and prevents the consequent 
ulceration. In cases in which a slough covers the surface, Mr. H. removes it, a 
practice we have already reprobated, and then applies the nitrate of silver, 
with the effect of producing an adherent eschar and a cure. In one case, in 
which, after a burn, the part was healed over, and a considerable cicatrix formed 
resembling a fungus, and attended with severe pain, the nitrate of silver remov- 
ed all inflammation and pain. In very extensive recent burns, Mr. H. has never 
had an opportunity of using the nitrate of silver; a case of extensive scald has 
however been recorded in a late number of the Edinburgh Medical and Surgi- 
cal Journal, which seems to confirm the anticipations of the utility of the re- 
medy entertained by Mr. H.; we shall therefore insert it in our Periscope. 

In an appendix, Mr. H. introduces some cases of a desultory character which 
* This plan will be found described in our Second Volume, p. 407.— Erf. 



v^ Manual of Materia Medica and Pharmacy. 185 

he could not well embody in the work. They relate to the use of nitrate of sil- 
ver as a blister, in gun-shot wounds, in neuralgia, contracted rectum, ulceration 
of the tongue, irritable ulceration of the eye, fungous ulcer of the navel in in- 
fants, and in the treatment of corns. 

A letter from Mr. Webster of Dalworth, and another from Mr. Tobias Browne 
of Camberwell, in which the writers bear their testimony to having used the 
nitrate of silver with advantage in various cases, are also given in a second ap- 
pendix. 

Mr. Higginbottom has but seldom used the nitrate of silver as a blister, but in 
the cases in which he has employed it, he states the effects to have been very sa- 
tisfactory. He is persuaded that it possesses a decided superiority over cantha- 
rides in many cases, causing less irritation, and being more prompt in its action 
and also as not inducing strangury. It induces a very copious discharge with- 
out heat or pain after the first few hours. The vesicated part heals about the 
fifth day without leaving the least ulceration. 

Three cases of neuralgia are related in which the nitrate of silver was ap- 
plied as in external inflammation, along the course of the, pain, with marked 
relief. 



XXII. A Manual of Materia Medica and Pharmacy^ comprising a Concise De- 
scription of the Articles used in Medicine,- luith Observations on the Proper Mode 
of Combining and Administering them: Also the Formula for the Officinal Pre- 
parations of the London, Edinburgh, Dublin, Parisian, American, and most of 
the Continental PharmacopoeiaSy- together with a Table of the Principal Medici- 
nal Plants. From the French of H. M. Edwards, M. D. and P. Vavasseuh, 
, M. I). Corrected and Adapted to British Practice. By John Davies, M. R. 
C. S. Surgeon of the Hert's Militia^ late Editor of the London Medical and 
Surgical Journal, &c. pp. 490. 8vo. London, 1831. 

We have heard of a book published in this country some years since, in which 
the publisher modestly inserted his own name in the title page for that of the 
author, thus reaping at the same time literary fame and pecuniary emolument? 
and we have actually in our possession a work translated from the French, with 
a few additions, in which the author is merely noticed in the preface, as having 
written a very imperfect book on the same subject, whilst the translator and 
compiler modestly figures on the title page as the author! These were, how- 
ever, bungling and easily to be detected attempts at fraud, and are not to be 
compared to the judicious management exhibited by the editor of the manual, 
the title of which is at the head of this article. Indeed we do not recollect ever 
to have met with what appears to be a more ingenious artificeto secure to one's 
self the credit of other people^s labour, without actually laying claim to it, than 
that displayed in the publication under consideration. We say appears to be, 
for it would be malicious in the extreme to suppose that the surgeon of the 
Hert's militia could have imbibed so little honour from his gallant associates 
as to desire to appropriate to himself merit which does not belong to him. We 
venture, however, to assert that ninety persons in a hundred who would read 
that work, would receive the impression that Mr. Davies was the translator, and 
if a suspicion of his not being so, did perchance flash across their rninds, they 
No. XVIL— Nov. 1831. 17 



186 Bibliographical Notices, 

would, on comparing" the translation with the original, and observing the nu- 
merous additions, regard him, at least as the author of the latter. And yet this 
would be entirely erroneous, nor has Mr. Davies anywhere claimed being either 
the translator or the author of all the additions. 

Indeed were Dr. Togno and Mr. Durand to say %o Mr. Davies, " Sir, you 
have taken our translation of Drs. Edwards and Vavasseur's Materia Medica, 
with our numerous additions, without any acknowledgment of your obligations 
to us — you have published them as being corrected and adapted to British 
practice by you, and in the preface state your having added some new matter;" 
he might reply, " Gentlemen, I have made no claims to being the translator, on 
the contrary, to remove any doubt as to my having taken advantage of your la- 
bours, and to enable you at once to prove it, I have carefully preserved in my 
edition even your typographical errors;— as to correcting and adapting it to Bri- 
tish practice, I have mystified your observations on the wax-myrtle so as to ren- 
der them perfectly unintelligible; — and of new matter I have inserted three pa- 
ragraphs of nearly four and a quarter lines each, relating to well-known Eng- 
lish mineral waters; I have introduced into the list of wines two, Craisin and 
currant,) and I have also added five notes, making in all thirty-two lines." To 
all this what rejoinder can Dr. Togno and Mr. Durand make? We hope they 
will not be so ill-natured as to say that Mr. Davies has exhibited more talents 
for another profession than for his own, or take advantage of his not having 
made any positive claim to candour, to deny him the possession of that virtue. 

So far, however, as we are concerned as reviewers, it is only necessary 
for us to state, that Mr. Davies has republished Dr. Togno and Mr. Du- 
rand's translation of the valuable Manual of Materia Medica of Drs. Edwards and 
Vavasseur, with a few additions and alterations, the most striking of the latter 
being the confounding of the'' additions made by the translators, and even his 
own three little sentences with the original, so that it is impossible to distin- 
guish what belongs to the authors of the original work, what to the American 
translators, and what to the English editor, without a careful comparison of 
the three works; and thus by modestly omitting any distinguishing mark to his 
own three sentences, Mr. D. actually incurs the risk of having all the additions 
assigned to himself 

In showing his willingness to father the labours of Dr. Togno and Mr. Durand, 
he has paid them the highest compliment in his power, and one of which those 
gentlemen will no doubt be duly sensible. 



( 187 ) 



QUARTERLY PERISCOPE, 



FOREIGN INTELLIGENCE. 



ANATOMY. 

1. Anomalies in the Arterial System and in the GangUonary Nervous System, — 
M. JoDisr, interne de I'hospice des Enfanis-trouves, describes in the Journ.Universel 
et Hebdom. for June last a very interesting- instance of anomalous arrang-ement 
of the arterial system and gangiionic nervous system, occurring in a child who 
died in consequence of imperforate anus, the rectum terminating in a cul-de-sac 
an inch above the os coccyx. The aorta communicated freely with the pulmo- 
nary artery through the ductus arteriosus. It gave origin, before its curvature, 
to a trunk common to both carotids, which proceeded perpendicularly upwards; 
at its curvature it gave orig-in to the left subclavian, and finally to the right 
subclavian, which arising from the termination of the arch, passed transversely 
behind the oesophagus in front of the vertebral column, then entered between 
the scaleni. At the second lumbar vertebra the aorta gave off the coeliac trunk, 
the superior mesenteric, the right renal, (there was no left,) the spermatics, and 
divided into two branches; the first continuing in the direction of the aorta, and 
of almost equal size, gaveoff the inferior mesenteric, ran to the posterior parietes 
of the bladder in the median line, passed to its summit, and from thence to the um- 
bilicus, where it divided into two branches. It could be injected in this course to 
within half an inch of the umbilicus. The second branch arising at the posterior 
part of the aorta, at an acute angle with the preceding, of half the diameter, 
passed a little to the left in front of the spine, as fur as the sacro-vertebral an- 
gle. There it dipt into the pelvis, passed between the sacrum and rectum, form- 
ing a curve from the left to the right with the convexity downwards, and running 
upwards again in front of the right sacro-iUac symphysis, to terminate under the 
crural arch of the same side. In this course it furnished all the branches for the 
nourishment of the inferior part of the trunk and the lower extremities: 1st, at 
the sacro-vertebral angle, the right and left lumbar arteries. 2d. An artery 
distributed to the left lower limb, which corresponded tolerably well to the ex- 
ternal iliac artery, taking nearly the same direction, furnishing the same 
branches, but in addition supplying the iliac muscle with branches, which in the 
normal arrrangement, come from the hypogastric. 3d. Finally, from the convex- 
ity of the pelvic curve, successively arose, from the left to the right, most of 
the branches which are commonly given off by the two hypogastrics. The 
branches which exist are very small and imperfectly developed; the middle sa- 
cral artery was entirely wanting. 

The great sympathetic accompanied the arterial system in its irregularity — 
suitably developed at its superior part, it is but slightly so at its inferior, where 
a sacral ganglion only is found, not the coccygian one. 

The cerebrospinal nervous system did not participate in these anomalies. It 
was regular and fully developed. 

The relator of the case is of opinion that this simultaneous cessation in the 



188 QUARTERLY PERISCOPE. 

development of the intestine, the bone, the nervous and vascular system occurs 
more frequently than has been supposed. 

The anomaly presented by the superior portion of the vascular system have 
been several times previously observed, and are delineated in the g-reat work 
of Tiedemann. The singular disposition of the inferior portion, however, of 
this system, M. Jodin cannot find described in any of the works on anatomy. 

2. On the Perspiratory Vessels of the Skin. — Dr. Hake has published in the 
London Medical and Physical Journal, for .July last, some curious researches on 
the perspiratory vessels of the skin. It is well understood that the exterior 
surface of the skin is perpetually moistened by the transpiration of a saline 
fluid: during" the spring- of 1830, Dr. H. first observed the perspiration on the 
points of the fing-ers, *' to follow a determinate arrangement, of which the inves- 
tigation led to the conclusions which follow: at some of them, however, the 
French anatomist, Beclard, had previously arrived. * The surface of the skin,' 
says Beclard, ' presents small wrinkles peculiar to the epidermis in the palms 
and soles: these are prominent fines, separated by other depressed lines, run- 
ning in various and winding directions, and which are formed by rows of pa- 
pillae.' "In my notes I have preserved an account which to the above is dissi- 
milar but in language, the facts being the same; but there are some minute 
points which Beclard probably saw, without copying down: they are as follows. 

"1. On submitting the base of the ridge, or prominent line, to the micro- 
meter, its width was found to occupy one-fiftieth of an inch of space, whilst 
that of the groove, or depressed line, occupied only one three -hundredth part 
of an inch. 

*• 2. The furrows are concave from side to side, and from their edges, which 
are distinct, arise the sides of the ridges which meet above at an angle, and 
thus, with their attached base, produce the form of a prism. The width of 
either side is about one ninety-sixth part of an inch, but the sides themselves 
are differently occupied: the one being covered by papillae which are about one 
fiftieth of an inch remote from each other, andarr^gedin a regular series; the 
other side being occupied by superficial grooves, each of which passes from 
the porous aperture of a papilla, and descends into the groove: by the latter 
arrangement, the globule of perspiration which arises through the pore of the 
papilla, passes also into the groove, and thus is equally diffused over the sur- 
face. 

" 3. By dissecting away the ridge, layer by layer, to the level of the furrow, 
each new surface presents an opening, which is perpendicular to the spot for- 
merly occupied by the mouth above. 

*' On first observing these phenomena, there are three circumstances apt to 
cause deception: 1. Owing to the inclination of the sides of the ridges, the pa- 
pillae may appear to be in the furrow. 2. The papillae, if viewed from the sides 
which they occupy, seem to be on the summits of, or rather to constitute, the 
ridges. 3. If the ridges be viewed from the side on which the grooves are, the 
whole cuticular surface, owing to the meeting of grooves and furrows, looks re- 
ticulated. 

" The cutaneous surface is, on the back of the fingers, traversed by grooves 
of many sizes, which frequently, and in all directions, cross each other, so as 
ultimately to leave only so many spots of uninterrupted surface. When, in order 
to find out the ultimate design of all this, a powerful lens is preferred, it is soon 
discovered that the former structure is so deformed as to yield no information; 
in fact, it will not bear the action of a high magnifier; but a moderate lens, will 
without any distortion, suiTiciently enlarge the field of nature. If a mild per- 
spiration be present, glistening particles of fluid are here and there observed, 
generally at equal distances from each other; and thus they follow the courses 
of the grooves, not occupying their cavities, but the summits of their sides; this 
is the more remarkable on the dorsum of the second phalanx of the fingers, but 
consequent on the frequency of the decussation of grooves, even there is 



Anatomy, 189 

often confused. A superficial furrow may be occasionally traced, extending 
from a pore to a groove, but such is only to be regularly seen on the palms. 
The pores vary in size; those of the palmar surfaces being larger than on the 
backs of the fingers, and the latter than elsewhere? were I asked the reason 
of this variation, my experience would lead me to say, that it was instituted to 
give passage to a fluid more or less impregnated with saline matter. 

" On the back of the first phalanx, the texture of the cuticle is fine and 
translucid; observing which, I deemed it probable that a microscopic examina- 
tion might be attended wiih an useful result: by dint of care and labour, 1 was 
delighted with the sight of a few small and exquisitely attenuated vessels, of a 
red colour; they were directly under the cuticle, to all appearance, and, hav- 
ing emerged, they seemed to creep a little way, then open with red mouths, 
and become continuous with the epidermis. As far as could be distinguished, 
each vessel became first visible at a little distance from one pore, and, after a 
short course, opened to form the next. 

"After having soaked the hand in very hot water, and again dried it, I ex- 
amined the dorsal surface with the weakest power of the simple microscope, 
and found it regularly studded with aqueous globules, which, while the parts 
remained swoln, were no sooner removed than replaced. By a sudden and un- 
designed movement of the lens, a reticular work became visible, which seemed 
to be of vessels: although this appearance was as evident as if of far greater size, I 
doubted its reality, lest it should consist of so many grooves, which, in a pecu- 
liar light, might have the aspect of elevation; but, on a comparison with such 
as I knew to be only grooves, the distinction was marked. I have mentioned 
that there are left between the grooves only so many spots of uninterrupted 
surface: on these it is that the net- work above-mentioned exists: it is so distinct 
on the joints as to become visible, by practice, to the naked eye. On these 
perspiratory vessels I observed numerous projecting points, resembling trun- 
cated ramuscules of the prime branch. Under the light requisite to produce 
these phenomena to vision, the network has a beautiful blue colour. At the 
summits of the sides of grooves, (which on some joints sub-divide in the form 
of vessels,) it is that the vascular elevation is most conspicuous: one vessel I 
saw running down the side of a groove. The anastomoses of these vessels seem 
very frequent, and at different angles, especially at ninety, sixty, and one hun- 
dred and twenty degrees. At the apex of each papilla which is given off, the 
pore was visible if not occupied by sweat, and not of a red colour, like that 
discovered near the roots of the nails." 

'* Every one knows that the epidermis at the sides of the nails is much 
thicker than elsewhere. It was with a view to ascertain whether, and how, the 
pores are continued downwards, that I removed with scissors many layers of 
cuticle from those parts, and was astonished to see how well, not only the pores, 
but the ridges and gi'ooves, maintained their characteristics: however, when 
the epidermis, instead of being cut, is peeled off the palms, the layer which 
becomes exposed is precisely similar to that which is removed. But a fact, 
which I at that time observed, has since often attracted my attention, for I con- 
ceive it to be important, although simple: however dry the skin may be exter- 
nally, as soon as a layer is removed, the pores of the new surface are occupied 
by sweat. To account for the occasional aridity of the skin, hypothesis has al- 
most, of necessity, urged a spasm of the pores, and sudorifics have been said 
to have the property of relaxing the contraction. The above experiment de- 
monstrates the point in which the spasm resides. 

•* Much has been said concerning insensible perspiration. It is true that if 
the hand be presented to a mirror, its polished surface becomes tarnished; but 
this is owing to spontaneous evaporation from the excreted fluid. I have watch- 
ed the progress of perspiration often, and always seen it to arise in a liquid 
state: nor is there sufficient reason to suppose an additional set of pores for an 
insensible exhalation. 

*• The appearance which I have described as resembling a net-work of ves- 

17* 



190 QUARTERLY PERISCOPE. 

sels, I believe to be an elevation of cuticle corresponding' to the shape of the 
vessels beneath, which open at its surface. The thickness of the epidermis on 
the palms and soles, precludes the possibility of discovering the arrangement 
of the vessels which lead to that membrane, but we may infer a regular and 
fixed distribution, from the harmonious order of the pores themselves. 

*' Whether or not the perspiratory vessels were seen by Kaau and by Dr. 
Hunter, it must be certain that they proceed from the dermis to the epidermis: 
from the researches of Malpighi and his successors, it can be no less certain 
that there are dermoid vessels which open to supply the fluid of, if not to form, 
the rete mucosum. These facts, had they been considered, might have served 
in explanation of the question, why the fluid effused beneath the cuticle from 
blistering does not escape through the pores, although Bichat, as well as Mec- 
kel and others, have used hypothesis for its solution. The cantharides, when 
apphed to the skin, acts on the secreting vessels of the dermis, which pour 
out, in reply to their proper stimulus, a greater quantity of fluid on the cellu- 
lar tissue which invests its exterior surface, under the denomination of rete mu- 
cosum. How then can this fluid enter the porous vessels, which are continued 
from the dermis, and open only on the surface of the cuticle? 

"With regard to the mode of proceeding, it should be remarked that it is 
not through a strong, but rather through a weak light, that the objects on the 
skin are to be seen; that an egregious error is committed by those who use 
powerful magnifiers; and that those are not less mistaken who have searched 
for pores on the detached portions of the skin, instead of examining living parts 
during the performance of their functions." 

3. Malformation of the Uterus — M. Vidal describes a curious instance of this. 
The uterus was elongated, cylindrical, and had but a single fallopian tube, and 
a single ovary. No trace of the other fallopian tube or ovary, could be disco- 
vered on the most careful inspection. The left kidney was situated in the pel- 
vis. — Bulletin de la Soc. dnat. Far M, Berardf Jr. Secy. — Rev. Med. June, 
1831. 

4. Anomalous arrangement of the Aorta. — M. Crtiveilhier exhibited, not long 
since, to the Anatomical Society of Paris, a case in which the arch of the aorta 
passed behind the trachea and oesophagus, immediately in front of the spinal 
column. Four arteries arose from its convexity; nearest to the right side, the 
right primitive carotid, next the left primitive carotid, next the left subclavian; 
and nearest to the left side, the right subclavian. This last passed to the right 
side in front of the trachea and oesophagus. 

M. Berard, Jr. at the same time, exhibited another anomalous arrangement of 
these parts. The arch of the aorta, in its natural position, gave origin to the 
four arteries first noticed, and in the same order, but the right subclavian 
passed to the right side between the vertebral column and the trachea and 
oesophagus." — Ihid. 

5. Anomaly in the Pneumogastric Nerves. — M. Bignardi, professor of anatomy 
at Modena, has communicated to the Anatomical Society of Paris, the dissec- 
tion of a woman, in whom both pneumogastric nerves, presented in their whole 
course, a series of ganglions, some as large, others smaller, than the interverte- 
bral ganglions of the spinal nerves, which they also resembled in structure. The 
great sympathetic on the left side was atrophied, and on this side the ganglions 
of the pneumogastric were both larger and more numerous. This woman dur- 
ing life exhibited nothing remarkable, except that she had a most voracious 
appetite. — Mev. Medicate, June, 1831. 



Physiology. 191 



PHYSIOLOGY, 

6. Mechanism of the Human Voice during Singing.— M. Bennati some time 
since communicated to the Royal Academy of Sciences of Paris, a memoir on 
this subject. The following report of Baron Ctjvier exhibits an excellent ana- 
lysis of this interesting paper. 

The intention of the memoir is to make known the part performed by the 
velum palati, or rather the strait of the throat formed by the velum palati, 
its arches, and the base of the tongue. We are aware that of the physiologists 
■who have studied the organ of the voice, some have compared it to a stringed 
instrument, others to a reed instrument. M. Savart has compared it more hap- 
pily to a kind of bird-call, and has established that the two ligaments of the 
glottis, and the ventriculi which separate them, take an essential part in the 
primitive formation of the voice. He has shown, at the same time, that the na- 
ture of the walls of the mouth, its internal configuration, and the more or less 
of tension of the parts which form it, concur in modifying the primitive sound, 
and can more especially lower it by means which do not consist in the 
greater or less elevation and depression of the larynx, taken in its totality. 
M. Savart has not, however, paid attention to the special use of each of 
these parts, neither has he attended to that of the velum palati. In gene- 
ral, little attention has been paid to this second strait; through which the 
air which produces the voice, is obliged to pass. Fabricius, of Aquapendente, 
tad, nevertheless, remarked its importance, after having shown that the voice 
is formed at the larynx, after having made known the relations of elevation and 
depression of the larynx, and, in consequence, the variations in length of the 
buccal cavity. This illustrious anatomist also described the variations in width 
that the same organ undergoes in passing from grave to sharp sounds. Ferrien, 
long after, appears to have attended to the same considerations, and to have 
gone further than Fabricius: for, in terminating his memoir on the voice, he 
says, that the chordee vocales are not the organs of every kind of voice; that a 
certain guttural intonation, and a false treble of the same nature, are produced 
by a new organ, the existence of which he has declared, and which he pro- 
poses to make known in a new memoir. The promised memoir never appear- 
ed, and thus we know not of what organ he intended speaking; Hallerhas sup- 
posed it to be the velum palati, but, however, he has not said in what manner 
this organ concurred in forming the voice. 

In a thesis sustained at Tubingen, in 1781, M. Hellway stated, that in the 
false treble, the uvula contracted, whilst it did not change its shape in the or- 
dinary tone. This is, we believe, all that has been said hitherto of the part 
the velum palati plays in the production of the voice, before the appearance of 
this memoir. M. Bennati, who joins to the skill of the physician great ex- 
ercise in the art of singing, and who has one of the finest voices we know of, 
has paid particular attention to these motions: he has ascertained that the 
tongue itself, in elevating and depressing itself, or in forming itself into a 
hollow, exercises a powerful influence on the modulations, and that in order 
that the larynx may give any tone, it is necessary that the os hyoides'be firmly 
fixed in a determined position. He has, besides, recognised that the notes im- 
properly called de la tete, and false treble, are formed almost exclusively by the 
labour and the strongest contraction of the superiorpartof the vocal canal. He 
names them, in consequence, super laryngeal, and calls their union the second 
register, to distinguish them from the notes said to come from the chest, and 
which he had rather call laryngeal, and their ensemble, the Jirst register.' He 
does not mean to say, by that, that the larynx does not aid in forming the one, 
nor the throat the other; but he wishes merely to show the more essential part 
that the throat takes in forming those of the second register. In regard to the 
third register, of which some works on singing speak, he regards it as imagi- 
nary, and owing simply to the vibration, more or less powerful, of the last notes 



192 QUARTERLY PERISCOPE. 

of the first, and of the first notes of the second. Those singers whose voices 
are composed of two registers, have need of more art to manage the transition 
from one register to the other, so as to unite them in the ear, and are more 
easily fatigued than others. 

7. On the Connexion between the Maternal Vessels and Cord. By S. C. Hol- 
lAND, M. D. — The following experiments were performed in order to ascertain, if 
possible, the nature of the union existing between the maternal vessels and the 
cord. Some physiologists are said to have succeeded in passing injections from 
one to the other, proving, as they imagine, a direct connexion; but so many 
probable sources of error have been pointed out in their experiments, that the 
conclusions drawn from them are little to be depended upon. At one time 
substances have been injected which emit a strong odour^ at another, such as 
do not combine with the blood, as oil. Mercury, and the ordinary coloured in- 
jections have occasionally been used. There are great objections to the em- 
ployment of all substances, except the two latter, and these are not altogether 
unexceptionable. When camphor is conveyed from the maternal vessels to the 
placenta, it is quickly absorbed and carried with the blood into the cord or 
foetus. We have no means of ascertaining the time necessary for its absorp- 
tion. This will depend on circumstances with which we are imperfectly ac- 
quainted. "When a quantity of camphor," observes Majendie, "is injected 
into the veins of a dog, the blood soon takes a strong odour of camphor. After 
having made this injection into a bitch with pups, I extracted a foetus from the 
uterus; at the end of three or four minutes its blood had no odour of camphor; 
only a second foetus, extracted after a quarter of an hour, had a strong odour 
of camphor. It was the same with the other foetuses."* 

On account of the rapid absorption of substances which are sometimes in- 
jected, we are scarcely entitled to conchide, from their presence in the foetus, 
that a direct connexion exists between the vessels of the uterus and the cord. 
The employment of mercury or the ordinary coloured injection, is not entirely 
free from fallacy. If the connexion between the maternal vessels and the cord 
is indirect^ or in other words, if the blood which is poured into the placenta 
from the uterus, is absorbed by the minute ramifications of the umbilical vein, 
in place of circulating in a continuous current to the foetus, it is nevertheless 
obvious that those vessels which absorb, have open mouths in the direction of 
the uterus, whence the injection is transmitted, and, consequently, may, im- 
mediately after death, or whenever the vessels are similarly circumstanced, 
allow the propelled fluid to enter them. Beclard succeeded in injecting the 
uterus from the vessels of the cord in a woman who died during gestation. Ex- 
periments of the same kind have been repeatedly made by other physiologists, 
on the lower animals, but not with the same results. If, indeed, we grant that 
the experiment has been successful, in one or two instances, the positive evi- 
dence which can be produced is so equivocal in its nature, that it is wholly in- 
sufficient, in the face of numberless experiments of a contrary bearing, to es- 
tablish a direct connexion. The arterial blood in the general circulatory sys- 
tem terminates in veins, and, if we consider the nature of those vessels of which 
the cord is formed, and the manner in which the blood circulates in them, we 
shall observe the same fact. The arterial blood which flows into the placenta 
from the uterus, is conveyed by the umbihcal vein into the foetus, and the ve- 
nous blood which is poured into the placenta by the umbilical arteries, is car- 
ried into the system of the mother by the veins of the uterus. 

Experiment I. — A rabbit, about the end of gestation, was killed by prussic 
acid. A quarter of an hour after death, the tube of the mercurial injecting ap- 
paratus was fixed to the inferior portion of the aorta, immediately before its 
bifurcation into the iliac arteries. In a few minutes a great number of small 
vessels on the external surface of the uterus, were observed beautifully inject- 

* Trans, by Dr. Milligan p. 508, 



Physiology. 193 

ed. The process was carried on for about three-quarters of an hour, at which 
time it was necessary to discontinue it, in consequence of several vessels being 
ruptured. On opening" the uterus, the maternal portion of four placentae were 
found considerably injected, as well as a, few vessels on the foetal portion of two 
of them. No mercury whatever had passed into the vessels of the cord. 

Experiment II. — The object of this experiment was to ascertain, whether it 
were possible to inject the whole of the placenta and the vessels of the cord, 
with a very finely coloured composition injected from the inferior part of the 
aorta. A bitch, apparently within a few hours of pupping-, was killed by prussic 
acid, and the experiment was immediately commenced. The results of the ex- 
periment were not examined till the following- day. All the placentae were 
most distinctly and beautifully injected. The vessels of the cord hud received 
no part of the injection. Injected vessels were rea.dily traced from the uterus 
into the placenta. The best mode of showing- this, is to tear, under the water, 
the placenta gradually from the uterus. The results of this experiment were 
observed by my friends Drs. Knight and Favell, and Messrs. William Jackson, 
James Ray, and Samuel Gregory, surgeons. 

Experiment III. — A cat, near the end of gestation, was killed by the prussic 
acid, and left undisturbed for about two hours, it was then immersed for an 
hour and a half in warm water, after which a very fine injection was transmitted 
through the inferior portion of the aorta. Two days afterwards, one of the 
arteries going from the kitten to the placenta, was injected with mercury. On 
examining the placenta, the foetal portion was found to have received a consi- 
derable quantity of the coloured injection. The whole of the foetal surface 
presented a multitude of small vessels of an arborescent appearance. The ves- 
sels of the cord were in a natural state. The vessels of the foetal portion were 
fully injected with mercury. No connexion, however, could be traced between 
the two different kinds of injected vessels. 

Many experiments were performed on each of the foetuses, to ascertain the 
nature of the connexion between the uterus and the cord, which are not relat- 
ed, because the results were precisely the same as those which are given. 

In the first experiment there is nothing particularly worthy of observation, 
except the injected vessels on the foetal portion of the placenta. In the second 
experiment, the coloured injection had succeeded remarkably well. The ves- 
sels of the cord were, however, not in the least injected. The results of the 
third experiment are extremely interesting. In appearance, the whole of each 
placenta was fully injected, nevertheless, a great number of vessels on the foetal 
portion became very soon visible, on the employment of the mercurial injec- 
tion, showing that the coloured fluid had penetrated only one set of vessels.— 
Physiology of the Foetus, Liver, and Spleen. 

8. Case of complete absence of the Cerebellum, together with the Posterior 
Peduncles, and protuberances of the Cerebrum, in a young girl who died in 
her eleventh year. — Communicated by M. Combettk, resident in the hospital 
of St. Anthony, (Service de M. Kapeler.) — Alexandrine Labrosse was born 
at Versailles, in May, 1820. Her father possessed a strong and robust con- 
stitution, but her mother was weak and unhealthy, and moreover, accus- 
tomed to excesses of every description. This child was very feeble when 
born, but well formed — she continued extremely delicate and puny, and 
grew but slowly. She had not cut her first teeth at two years of age, and 
it was only after she had reached her third year, that she began to lisp a 
few words. M. Miquel, to whom I am indebted for these particulars, saw 
her for the first time in 1827, when he was informed by her father that she 
was five years old before she could stand alone. He was astonished at her small 
size, and remarked particularly the great feebleness of the extremities, f [^^^ 
symptom, joined to the want of intelligence in the child, and the impossibility 
of her articulating a word clearly, had induced M. Miquel to suspect some in- 
jury in the brain. He was several times called upon to prescribe for gastro- 



194 QUARTERLY PERISCOPE. 

intestinal Irritations, althoug-h these presented no remarkable peculiarities. 
The last time he saw her, which was after her ninth year, he found the pupils 
extremely dilated, from which he was led to suspect the presence of worms in 
the intestinal canal. He was about to direct anthelmintics, when the nurse in- 
formed him that the little patient kept her hands constantly applied over the 
genital parts. 

On the 12th of January, 1830, she was admitted into the Hospital des Orphe- 
lins, as a forsaken child. Her certificate of admission represented her as para- 
lysed in the abdominal extremities, speaking with difficidty, and that her dis- 
ease was owing- to a fright experienced by her nurse. 

In the letter addressed to the superintendant, requesting her admission, M. 
Miquel observes, "this little girl, although nine and a half years old, in conse- 
quence of the poor nourishment and little care she had received, is scarcely as 
large as a child of six years: this cause has arrested the development of both 
her physical and moral faculties." 

At the time of her entrance into the Orphelins, she was feeble, cachectic, 
and possessed of very little intelligence. Apparently indifferent to every thing 
surrounding her, she nevertheless manifested friendship and gratitude for those 
who rendered her any attentions. When spoken to, she rephed with difficulty 
and hesitation. Her limbs though extremely feeble, yet allowed her to walk, 
but she often fell down. She possessed the use of all her senses, eat mode- 
rately, and all the functions of nutrition were well performed. 

In the month of January, 1831, when seen by M. Combette, her condition 
was as follows: Her features indicated a deteriorated constitution, and possess- 
ed an air of stupidity. She lay constantly upon her back, with her head inclined 
to the left side, and she could scarcely move her limbs; which, however, exhibit- 
ed no diminution of sensibility. She had the free use of her hands. Her con- 
dition always manifested depression and dullness, and she seemed alike indiffer- 
ent to both pleasure and pain. When questioned, she replied simply yes or ?io, 
always however, correctly. 

For a long time she had been subject to glandular engorgements about the 
neck, and especially near the parotids, and for a fortnight had a carbuncle of no 
great size or violence, situated on the right buttock. On the three outermost 
toes on the same side, there existed an ulceration accompanied by a livid red- 
ness, from which there was a very abundant discharge of extremely foetid pus. 

Towards the middle of February, along with her other infirmities, Alexan- 
drine Labrosse had stomatitis, (as had many other children in the hospital,) 
complicated with symptoms of enteritis. After this she grew daily more and 
more feeble, exhausted by an incessant diarrhoea. 

She died on the 25th of March, 1831. Since her death, I have been posi- 
tively informed, that she was addicted to the habit of masturbation. The sisters 
have also assured me, that she was subject to epileptic convulsions, and that 
a few moments before death, she had experienced a violent general convulsion. 

Jlutopsy thirty hours after death. 

External Habit.— Body lank and emaciated. Skin discoloured. Large slough 
over the sacrum. A small livid wound on the right buttock, occasioned by the 
incisions I had made. The three diseased toes had a blackish and gangrenous 
appearance. Scrofulous engorgements upon the neck. 

Head. — Under the integuments of the cranium near the parietal protuberance 
of the right side, an ecchymosis existed about the size of a dollar. The cranium 
was rather thicker than usual. The meninges of the brain appeared healthy. 
The cerebrum appeared in a natural condition, except that it seemed to me 
comparatively very large. Dissected subsequently by M. Magendie, a small 
sanguineous effusion was found in the left posterior lobe, which did not appear 
to have existed long, and which was not more than two or three lines in diame- 
ter. The covering of the cerebellum being divided, the medulla oblongata 
cut at the occipital foramen, and the encephalic mass raised and inverted — 
the following appearances were observed: 

A large quantity of serum was discharged, filling the occipital fossae. In 



Physiology* 195 

place of the cerebellum, 1 found a gelatinous membrane of a semicircular form, 
attached to the medulla oblongata by two membranous and gelatinous peduncles. 
The one of these on the right side had been torn. Near these peduncles 1 found 
two small white isolated masses about the size of a pea. On one of these was found 
one of the branches of the fourth pair of nerves. The tuberculi quadrigemini 
were entire. On the posterior and inferior side there was the appearance of an 
erosion, in the midst of which the orifice of the canal of Sylvius appeared. It 
extended a little upon the medulla oblongata, making a slight alteration in the 
restiform, and in the olivary bodies. The fourth ventricle did not exist. There 
was no trace of a pons varolii, but without any appearance of want of substance. 
The anterior pyramidalia terminated in a fork by the cerebral peduncles. 

Of the cerebral nerves, I could only find the origin of the first, second, third 
and fourth pair, which appeared in a healthy state, except the latter, which 
was, as I have said, detached with the small white mass, of which I have spoken. 
Not having raised the brain myself, it was impossible for me to find the origin 
of the other pairs. They all however, existed, and could be easily perceived 
through the openings of the dura mater. They have, moreover, been subse- 
quently dissected by M. Magendie, and exhibited no peculiarity. 

The cerebral substance was of the ordinary consistence, but the medulla ob- 
longata appeared a little softened, especially about the erosion I have described, 
where there existed a kind of maceration. The occipital hollows were regu- 
larly formed, but appeared to me rather smaller then natural. The vertebral 
arteries existed. 1 cannot say how these were distributed, because they did 
not at first fix my attention. 

Spine. — A considerable quantity of serum ran from the spinal canal. The 
spinal marrow offered nothing remarkable. 

Chest. — Both lobes of the lungs crepitated, but their whole surface was cover- 
ed with miliary tubercles, which were also found in the parenchyma. The 
cavity of each pleura contained two or three ounces of serosity. The pericar- 
dium and heart offered nothing in particular. 

Abdomen. — The intestinal circumvolutions were of a deep red colour. The 
mucous membrane of the stomach exhibited a number of red dots on a slate 
coloured ground, and near the anterior part and great arch, there were five or 
six brown patches. In the middle of each of these, a small ulceration with ele- 
vated and perpendicular borders appeared. This membrane was otherwise of 
its ordinary consistence and thickness. 

The mucous coat of the duodenum presented no ulceration. It was slightly 
red, and its foUicles prominent. After this, throughout the whole tract of the 
small intestine, it was of a livid red colour, presenting numerous ulcerations, es- 
pecially about the ileo-ccEcal valve. The large intestines presented nothing in 
particular. 

The mesenteric ganglions were larger than ordinary. The liver was of an 
extraordinary size, and of a pale colour. 

The Organs of Generation. — The finger could readily be introduced into the 

vagina. The hymen did not exist. The labia were of a lively red colour, 

and bore the appearance of having been frequently Irritated. The ovaries and 

uterus existed, but they appeared smaller than usual with girls of the same age. 

The kidneys, spleen, &c. were in a natural state. 

Conclusions. — This singular case is calculated to excite the particular atten- 
tion of physicians of the physiological school, and presents no less interest for 
pathologists. I regret exceedingly, my inability to say any thing relative to 
the moral condition of this child previous to its entrance into the hospital, and 
am still in the expectation of receiving further information. Should any parti- 
culars be offered, I shall immediately communicate them. — Bull, de la Sac. 
Anat. — Rev. Medicale, April, 1831. 

9. Extraordinary Case of Discharge of Oil from the Bowels, and Sugar from 
the Urinary Passages. — A curious instance of this was related by Dr. Eliiotso«- 



196 QUARTERLY PERISCOPE. 

in a late clinical lecture. It occurred in a man who, for three jj'ears, has dis- 
charged oil in large quantities from his intestines. The man is also labouring 
under diabetes, discharging sugar from the urethra, while from his rectum he 
daily pours forth an abundance of oil. The case must be very interesting to 
chemists, on account of such a double manufacture going on. Four of the first 
chemists in England have had Specimens, which they have examined, and 
they found the discharge to be genuine oil. After a motion it flows from 
him liquid, and tlien it concretes. It swims in yellow flakes over the con- 
tents of the vessel, of the colour of unblanched bees' wax. A case of this 
kind is mentioned by Mr. Howship in one of his works; he says the lady took 
a pint of oil, and it immediately stopped the manufacture. I gave this man six 
ounces of sweet oil, said Dr. E. "not knowing what to do with the case, and 
trusting to the one recorded by Mr. Howship. He took three ounces, and was 
sick, he then took the other three, and they stayed down; and he has made 
very little oil since. He has phthisis into the bargain, so that he is producing 
three foreign substances— oil, sugar, and pus. Of course he must die. He has 
been inhaling chlorine with very great advantage: it has diminished the expec- 
toration, and also the cough exceedingly, so that he has hardly any thing to 
complain of. He is sinking under the disease of his lungs, kidney, and intes- 
tines, but he will hardly allow that he now suifers at all. I may mention that I 
tried iodine for his phthisis, but it distressed him very much even in the most 
minute quantity; the chlorine, however, he bears perfectly well." — London 
Medical Gazette^ JunCy 1831. 

10. Influence of the Genital Organs on the Cerehellum.— Baron Larret, in his 
Clinique Chirurgicale, states, that " The genital organs seem to have a marked in- 
fluence upon the cerebellum, for when they are removed by disease, or any 
other means, the occipital region of the cranium and cerebellum gradually ex- 
periences such a sensible reduction, that the occipital bumps, which had been 
more or less protuberant before, disappear, and the whole occipital region of 
the head is diminished in proportion. We have verified this change of dimen- 
sion in a great number of soldiers, who had been operated upon for sarcocele, 
and when one testicle only was removed there was only a reduction of that por- 
tion of the cerebellum and occipital bump, which belongs to the same side, with 
the extirpated testicle." 

A soldier, who had been wounded in the occipital region by a splinter of 
wood, was attacked with all the symptoms of inflamed cerebellum, and, in des- 
pite of every thing which was done, they were only dissipated by the appear- 
ance of an abscess in the nape, which opened spontaneously. In about three 
months after the accident he rejoined his regiment, and many years elapsed be- 
fore he again came under Larrey's notice. He was then so extremely altered 
in appearance, that the author mistook him for a young conscript, who had been 
exhausted by some asthenic disease. He was 32 years of age, of middle size, 
but thin and pale, his eyes were depressed, his lips blanched, his hair, more 
especially that which covered his occiput, was thin and bristled, and a feeling 
of pain and coldness was always experienced in the back part of his head. He 
was beardless, his voice was feminine, and as some of the assistants were not 
without suspicion of his sex, a more minute examination was considered neces- 
sary. 

"To our great surprise, (says Larrey,) we found his genital organs reduced 
to the size of those of an infant some months old. His penis was not more than 
five or six lines long, and two or three lines thick, it never exhibited any degree 
of erection, and his testicles were so wasted as scarcely to equal in size a small 
bean." 

A Swiss soldier of the guards, named Granfort, fifty years of age, was re- 
ceived into hospital for an erysipelatous affection of the left side of the face, 
attended with habitual pain and weight of head, deafness of the left ear, and a 
great difficulty of speech. The pulse was febrile, and the strength was much 



Physiology, 197 

reduced. These symptoms were occasioned by a fall, which this man had sus- 
tained a few days before the appearance of tlie erysipelas. Emollients were 
externally applied^ diluents and anodynes were internally administered. After 
some days fluctuation was felt, and a deep incision discovered a large abscess in 
the neighbourhood of the left mastoid process, which was denuded and carious 
in one point, where a communication had been formed between the internal 
ear, which was the seat of the abscess, and the external surface upon which it 
pointed. Five or six weeks afterwards the walls of this abscess were clean 
and began to heal; still, however, pains in the occiput, a sense of weight in the 
head, and considerable difficulty in keeping the head from falhng towards the 
affected side, were complained of. He seldom spoke, and when he did he ar- 
ticulated badly. The integuments covering the occiput were very sensible, 
the arm and hand of the left side were threatened with palsy, but his mind was 
completely undisturbed. After two months convalescence this soldier fell into 
a state of lethargy, and died twenty-four hours afterwards. On inspection the 
dura mater appeared of a deep brown, the arachnoid was opaque and in some 
parts of a dull white, these membranes and the cerebral mass were filled with 
turgid blood-vessels, the consistence of the brain was firmer than natural, the 
lateral ventricles contained some colourless fluid, three spoonfuls of pus were 
found in the cerebellum, the right lobe was diminished, and the medullary sub- 
stance forming the arbor vitse was dense and of a gray colour. The purulent 
matter was effused underneath the pons varolii and into the lambdoidal fossa, 
where the carious opening lay which communicated with the internal ear, and 
around which the membranes had contracted adhesions. "The scrotum and 
penis were so reduced from their primitive volume, that one might consider 
them as being in the second stage of atrophy." 

"John Baptist Dande, aged 26, of a scrofulous habit, who had been formerly 
under treatment for diseased spine, was attacked with pains in the left testicle, 
which swelled, and obliged him to apply for relief. It was at first regarded as 
a consequence of suppressed gonorrhoea, although the soldier denied that he 
ever had any syphilitic symptoms, and he was treated in accordance with this 
view. The tumefaction of the testicle increased however, and extirpation of 
this organ was at length determined on. After two months the cure was sup- 
posed to be complete, and Dande rejoined his regiment; but in about six 
months afterwards the other testicle became attacked with symptoms of a simi- 
lar character to those which had been experienced formerly, and every effort 
to resolve the swelling and to save the organ being made in vain, the appear- 
ance of symptomatic fever and other malignant tokens of inveterate disease 
suggested the necessity of a second operation. No disagreeable symptoms fol- 
lowed — 

"But, one remarkable thing is, that the nape now appears sensibly depressed, 
that the occipital bump, corresponding with the testicle first amputated, is 
much smaller than the right. The body is likewise emaciated, the beard and 
mustaches are nearly fallen off, and, in fine, it is obvious that the total loss of 
the genital organs has had a very marked effect upon the cerebellum, since the 
occipital region offers a profound and anormal depression — the consequence of 
atrophy, which also affected all the bones of the skull, the skin covering the 
face, and the beard." — Medlco-Chirurgical Review, July, 1831« 

11. MropJiy of one-half of the Encephalon. — In our seventh volume, p. 224, 
we noticed an instance of this reported to the Anatomical Society of Paris, by 
M. BoDET; we learn from the Rev. Medicah for June, 1831, that an entirely 
similar case has been since communicated to the same Society, by M. BelL 

12. Function of the Optic and Olfactory Nerves. — M. Vidal has communicated 
to the Anatomical Society of Paris, a case of fungous tumour of the dura mater 
at the base of the cranium. The optic and olfactory nerves were compressed 
and destroyed by the tumour, whilst the fifth pair remained perfectly unaffected,. 

No. XVll.— Nov. 1831. 18 



198 QUARTERLY PERISCOPE. 

Vision and the sense of smell were destroyed. This fact confirms certain ex- 
periments of M. Majendie, from which it results that if the trifacial nerve is ne- 
cessary to vision, at least it cannot be considered as the exclusive organ of this 
function. It also tends to prove, in opposition to the opinion of the celebrated 
physiologist just alluded to, that the olfactory nerve enjoys the same preroga- 
tives as the optic, in relation to the sense to which it transmits impressions. — 
Compte rendu des travaux de la Soc. dnat. — Bev. Med. June, 1831. 

13. Extra-Uterine Foetation. — Professor Chaussier is of opinion that the de- 
velopment of the uterus, and the secretion of the membrana decidua are phe- 
nomena inseparable from extra-uterine pregnancy. Various observations have 
shown that this opinion is too exclusive, and the point may be now considered 
as settled, M. Gaussail having recently met with the uterus in its ordinary con- 
dition in a female gone her full term, with an extra-uterine foetus. — Ibid. 

14. Pulsation in the whole Vascular System. — Dr. David Badham of Glasgow, 
has communicated to the editor of the London Medical Gazette, the case of a man 
affected with paralysis of the right side, in whom the following very interesting 
peculiarities of vascular action presented themselves. 

" 1st. The whole venous system of vessels was observed to pulsate. On look- 
ing attentively at any of the superficial veins on the hand, arm, or elsewhere, 
it was quite evident that they moved, and in that wavy manner which has several 
times been noticed in the jugulars, but very rarely, I believe, over the system 
generally. The jugulars themselves were seen to dilate and contract alternately, 
much in the same way that a leech is observed to do when sucking. 

*' As to the arteries: 1st, the minutest twigs of this system of vessels are ob- 
served to pulsate. I cannot give a better idea of the extent to which this 
phenomenon has proceeded than by mentioning, that the small branches of the 
coronary artery of the mouth may be seen and felt to pulsate over the nose and 
Up to the inner canthus of the eye; that in consequence of this inordinate action 
in vessels of so small a calibre the surface of the whole skin seems alive; that 
so enormous (for that is the word) is the impulse of the carotids and subclavians, 
on the paralysed side particularly, that at each pulsation the patient seems to 
receive a shock as if he were slightly electrified. 2. The arterial action of the 
paralysed side is nearly twice as strong as that of the other, affording a striking 
evidence of the independent action of the arteries. 3. The thrilling purr is 
most distinctly felt over the subclavians and carotids of both sides, but best on 
the side where the arterial action is least: on grasping the wrists of the patient 
within my hand, I also seem to recognise it in the pulse. This purr, according 
to Laennec, never occurs alone, but is always accompanied by the ''bellows 
blast;" accordingly, 4thly, over whatever artery the cylinder is placed, a bruit 
de souffiet is heard: this, in the larger vessels, was always more perfect on that 
side where the arterial action was least, but it was easily produced in full per- 
fection on the other by simply compressing the artery from above, and so di- 
minishing its action; so that we may infer from this, that too much action in the 
arteries is destructive of this phenomenon. The bruit de souffiet is loud over 
the radial, ulnar, and other less considerable arteries; it is also attended with a 
sort of chirping, particularly at the right side. It extends likewise to the heart. 
The action of this organ is moderate and normal. A well-marked bruit de 
rape, synchronous with the pulse, is heard over the third rib of the right side, 
near its junction with the sternum. As there is no deficiency in the natural 
impulse of the right ventricle of the heart, so there is no evidence of there being 
dilatation of this side; and we have here the remarkable phenomenon o/ jow/- 
sation of the jugulars, without this organic lesion of the heart, with which all 
writers on this subject have held it to be inseparable." 

A case, the reverse of this, in which there was dilatation of the right auricle, 
without jugular pulsation, will be found in our department of Pathology, p. 
203, No. 18. 



Pathology. 199 



PATHOLOGY. 

15. Memarkable Instance of Hsemorrhagic Tendency in a Family. — Dr. RiEck- 
E3!f, a German physician, in a recent work, has given an account of a very re- 
markable hereditary transmission of the haemorrhceal diathesis through several 
individuals in a family. The father of this family, Ernest P. was a husbandman 
and joiner, who had always enjoyed good health, and at the time of the publi- 
cation of Dr. Riecken's work, in 1829, was in his eighty-sixth year. His second 
wife, by whom he had the children to be mentioned presently, was of delicate 
health. In her thirtieth year she was attacked with rheumatic gout, and, after 
this ceased, with curvature of the spine, asthmatic complaints, and frequent 
pain under the breast bone. Bye-and-bye signs of water in the chest came on, 
general dropsy followed, and she died of that disease in her sixty-sixth year. 
Neither the wife nor the husband was ever subject to haemorrhage, or to pete- 
chial spots. This couple had twelve children, five sons and seven daughters, 
of whom four died of small-pox, one of eclampsia, and three boys. and one girl 
of haemorrhagy. 

WiUiam Louis, one of the three boys, enjoyed good health till his fourth 
year, when he was attacked with bleeding from the left nostril, which conti- 
nued, with occasional intermissions, for eight days, and was only arrested by 
stopping up both nostrils firmly with the Boletus igniarius, (zundschvvamm.) 
Two days afterwards, he was seized with anxiety and a sense of constriction in 
the praecordia, attended by swelling and tenderness there, then with cold 
sweating and deadly paleness, and at lengtli with vomiting of black fluid blood, 
which repeatedly returned, and proved fatal in the course of a week. — In an- 
other of the boys, John Christian William, blue spots, unattended with pain, 
frequently broke out on the skin between his first and eleventh years, but were 
not accompanied by haemorrhage. In his tenth year he was attacked with vio- 
lent rending pain in the extremities, more especially in the limbs, which abated 
in a month and a half, after a hard tumour formed on the left knee. This tu- 
mour had been present for a year and a half, when he was suddenly seized with 
violent tooth-ache in the foremost grinder of the left side of the lower jaw, and 
the pain was so excruciating that he consented to the extraction of the tooth. 
The tooth was quite healthy. A gush of fluid blood immediately took place 
from the cavity, and nothing could check it. The poor boy gradually became 
blanched like wax, and expired on the eighth day. — Philip Henry, the third 
boy, presented the appearance of blue spots on the skin, particularly of the 
buttocks, even during the first year of his life, yet without any signs of weak- 
ness. When a year and a quarter old, he died while vomiting fluid blood which 
had begun the day before, without any previous appearance of ill health. The 
daughter died four days after birth in consequence of haemorrhage after the di- 
vision of the froenum of the tongue. 

The same striking constitutional infirmity likewise appeared among the 
grandchildren of Ernest P. born of his youngest daughter, Louisa Catherine. 
This woman, who is still alive, and in the thirty-second year of her age, is short 
in stature, and light haired, has gray eyes, and a delicate, fair complexion. She 
never had purple spots, or exhibited any tendency to haemorrhage; nay wounds, 
and even apertures in veins made by the operation of blood-letting, healed in 
the usual manner. The menses commenced in her thirteenth year, and were 
usually rather abundant, and of eight days' continuance. She suffered much 
from tooth-ache and neuralgic affections of the extremities, was indeed seldom 
altogether free of wandering pains, and in her pregnancies was so much affect- 
ed by a tendency to plethora that it was frequently necessary to withdraw 
blood. The blood coagulated more slowly than usual, was very dark, contain- 
ed much serum, and presented a thin buffy coat. The haemorrhage immediate- 
ly after delivery, as well as the lochial discharge, was always profuse. Her hus- 
band is a stout, healthy man. They have had six children, four boys and two 



200 QUARTERLY PERISCOPE. 

girls, of whom only the eldest girl and youngest boy are now alive. The re- 
maining girl died of convulsions when nine months old, and the three boys of 
haemorrhage. The surviving girl is very healthy, and never had either blue 
spots or bleedings. 

The four boys were all born easily, and the navel healed up without haemor- 
rhage. They all had a disproportionately large head, with unusually loose su- 
tures, and fontanelles of uncommon size and slowly filled up. Their bodies 
were delicately and regularly formed, the nails were of the natural appearance, 
the skin fair and delicate, with the veins shining distinctly through, and the 
countenance pale, sickly, and bloated. They had all blue eyes, and one of 
them fair, but the three others black hair. Dentition went on in all in the usual 
manner. They were very lively, of mild dispositions, and the eldest showed 
much cleverness. The operation of vaccination, which was performed by in- 
cisions, was not followed by any untoward effects. All had from birth a very 
fetid discharge of a white, flaky, puriform mucus from each ear. 

The eldest of these boys manifested a distinct tendency to haemorrhage in 
the seventh nrionth: dark, irregular spots appeared on various parts of the skin, 
varying in size from that of an achtgroschen piece to that of half a man's hand, 
and without any external injury; and these were at first pale red, but as they 
increased in size rapidly became bluish -black, and then reddish-blue, bluish- 
green, and dirty -yellow as they were disappearing. At times the body was en- 
tirely covered with them. They were attended with hardness and swelling, but 
not with pain. The first attack of heemorrhage occurred in his first year in con- 
sequence of his having bitten the tip of his tongue, and it was not arrested till 
various artificial means had been tried in vain, and nature accomplished it after 
the child was reduced to the lowest possible state of exhaustion. When he was 
eighteen months old a second attack took place in the form of epistaxis, which 
was not checked till he was almost at the point of death; when it ceased under 
the use of the acid elixir of Haller and laudanum, and during the deep sleep 
which supervened. On his awaking, general convulsions attacked him; then 
deep sleep returned, and after this he awoke refreshed, and soon recovered. 
From this period till he was four years and a half old, he had regularly every 
three months an attack of epistaxis from the left nostril, which continued be- 
tween four and ten days with occasional intermissions, and was preceded by 
lancinating head-ache, sounding in the ears, excitement of the pulse, flushing 
of the face, and lividity of the lobes of the ears. The blood was dark red, thin, 
without tendency to coagulation, and towards the close of the paroxysm pale 
dirty-red in colour. The haemorrhage never ceased till the child, after repeat- 
ed fainting fits, was brought almost to the point of death. In his fourth year he 
complained much of shifting pains, particularly in the left thigh, which were 
particularly troublesome before the customary bleedings or on any change of 
weather, but became much less so on a swelling of the knee-joint making its 
appearance. The swelhng confined him for some time to bed; but it was di- 
minished by proper remedies; upon which a fresh attack of haemorrhage occur- 
red; and after this the pains ceased. The child, however, was pale and exhaust- 
ed, and in two days he died with all the symptoms of inflammation of the 
bowels. Sulphate of soda had no eflfect in checking the haemorrhagies in this 
case. 

In the second boy, the blue spots began to appear fourteen weeks after 
birth. When ten months old, a furuncle formed in the right arm-pit, which was 
carefully opened. At first pus alone issued; but afterwards violent haemorrhage 
ensued, which continued for three days, notwithstanding the constant use of 
tents and compresses dipped in alum. After the lapse of nearly three-quarters 
of a year, an almost fatal haemorrhage followed a trifling injury of the froenum 
of the lower lip; and this was not checked till on the third day the actual cau- 
tery was resorted to. After this, with the exception of the blue spots, the child 
was healthy, and became plump and strong. But when two years and a half 
old, plethoric symptoms began to show themselves as in his older brother's 



Pathology, 201 

case; and he was attacked with pleuro-peripneumony. Dr. Riecken avoided 
all evacuations of blood, and brought him through his illness by other antiphlo- 
gistic remedies. Suddenly, however, after a return of fever, copious bleeding 
took place from both nostrils, for which all the usual means, including Glau- 
ber's salt, were in vain put in requisition; and it was not till the child had re- 
peatedly fainted, and was as pale as a corpse, and till the blood had in the end 
flowed for six hours as pale as bloody serum, that the haemorrhage ceased spon- 
taneously. Half a year afterwards he was attacked by flying pains in the ex- 
tremities, followed by swelling in the left ankle, and, when this disappeared, 
by swelling in the left knee. Recovery, however, was gradually so far accom- 
plished, that the child could walk again, when, in an accidental fall, a small 
wound not larger than a pin's head was inflicted on the point of the tongue. 
Profuse haemorrhage commenced, and for five days it continued, although every 
conceivable remedy was tried, including three applications of the cauterizing* 
iron, till at length the breathing and pulse ceased, the skin became icy cold, 
the eyes lost their lustre, and death was believed to be at hand. After a time 
signs of animation appeared; the haemorrhage was found to have ceased, and 
the child became convalescent. In fourteen days he began to complain of oc- 
casional stitches under the ribs of the left side, accompanied with dry cough: 
and during a fit of coughing, blood began to gush from both nostrils. The blood 
was fluid, thin, brownish in colour and fetid. It continued to flow in spite of 
every remedy which could be thought of, and the little patient soon died 
shghtly convulsed. 

The third boy, in consequence of the froenum of the tongue being unskil- 
fully divided, was attacked when three months old with profuse haemorrhage, 
which lasted for three days, and only yielded after repeated apphcations of the 
actual cautery. The blue spots did not begin to show themselves till the sixth 
month. The plethoric symptoms observed in the two former cases appeared 
also in the present instance about the thirteenth month, and especially some 
weeks before his death, which took place after an attack of haemorrhage of two 
days' continuance, occasioned by an injury of the tip of the tongue with an in- 
cisor tooth. On this last occasion repeated cauterization was of no use. 

In the youngest boy, who is still alive, a chronic, itchy eruption of the face 
was added to the discharge from the ear, which he had in common with his 
brothers. Blue spots began to appear on the skin four months after birth. But 
subsequently to the administration of ass-colt liver-oil (!) to the mother, both 
the eruption and the livid spots disappeared. Whenever the mother intermit- 
ted the oil the spots reappeared; and whenever she resumed it, the discharge 
from the child's ear dried up, the spots ceased to form; nay, on one occasion 
he sustained a wound of the ring finger with a sharp knife, yet the hemorrhage 
was not greater than in other children. Subsequently a furuncle on the shoul- 
der was opened, and a second time a wound accidentally inflicted without any 
particular haemorrhage. The farther history of this case is not given. 

Besides the mother of this family, Ernest P. had two other daughters, who, 
together with their families, never suffered from haemorrhage or ecchymosis; 
but they were very liable to gout, rheumatism, chronic abscesses, and erup- 
tions. Among his ancestors and collaterals there was no one ever liable to hae- 
morrhage; nor can the least relationship be traced between his family and any 
of the previously ascertained instances of families possessing this constitutional 
infirmity. 

The author in his general remarks seems disposed to ascribe the constitu- 
tional haemorrhagic diathesis to a gouty taint; but this is surely an erroneous 
idea, otherwise it ought to be much more frequently met with. In tie present, 
as in every previously recorded instance, it is very remarkable that the in- 
firmity was confined to the male branches of the family, and that, nevertheless, 
it was transmitted through the female branch to the males of the next gene- 
ration.— £c?. Med. and Surg. Journ. July^ 1831, from Medizenisch-Chirurgiscke 
Zeitungy Nov. 15, 1830. 

18* 



202 QUARTERLY PERISCOPE. 

16. Case of General Emphysema produced by Combustible Gas. — The follow- 
ing case was presented to the Royal Academy of Medicine by M. Ballt. A 
man, twenty-five years of ag-e, was admitted in the Hopital Cochin on the fif- 
teenth day of typhoid fever. He complained of violent pain in the left thigh, 
which, as well as the scrotum, was swelled; and in his delirium he talked of 
having- been bitten in the knee by a dog; but no information to this effect could 
be procured after a diligent inquiry. He died on the day after admission; and 
in eight hours the body was examined. 

Blood had issued from the nose, and from the surface of the skin of the 
thighs and head, where the cuticle had been stripped. The whole body was 
emphysematous, but especially the left leg. This was twice its natural size, had 
a brownish-violet colour^ and was extensively covered with black and white 
phlyctaense; and a reddish serosity, mixed with air-bubbles, issued from the black 
ones. This limb resounded when struck, and crepitated when handled. The 
belly was much distended with gases. The face and temples were livid; and 
when the skin there was divided a great deal of reddish-black blood issued. 
The brain and lungs did not present any unnatural appearance; the heart was 
pale and empty; the intestines presented the usual organic derangements ob- 
served in typhus, (enlargement, induration, and ulceration of the glands of 
Peyer and Brunner.) Bubbles of air filled the vessels of the pia mater and left 
saphena vein. The lymphatic glands of the mesentery were enlarged, and con- 
tained a gas which took fire at a candle and exploded. The same phenomenon 
was witnessed after scarifications of the legs, thighs, and scrotum. A puncture 
having been made in the belly, the gas wliich issued took fire also, and formed 
a flame blue at the base, white at the apex, and which burned for some time. 
The combustion likewise extended to the edge of the opening made with the 
trochar; and the edges became black and were consumed, so that the aperture 
was rendered of twice its previous diameter. The gas contained in the subcu- 
taneous cellular tissue was inflammable like that in other parts. 

M. Bally considers that this evolution of inflammable gas was not a pheno- 
menon which occurred after death only, and puts the, question, whether the 
case throws any light on the spontaneous combustion of the human body? — • 
Archives Gmerales, Jan. 1831. 

17. On the Respective Prevalence of Pneumonia at different »3ges, and in the 
Two Sides of the Chest. — M. Lombard has given an account in the Archives Gene- 
rales, for January last, of some very interesting investigations made by him into 
the respective prevalence of pneumonia in the two sides of the chest, and his 
results show that in France the right lung is more frequently affected than the 
left. We take the following analysis of his labours from the Edinburgh Medical 
and Surgical Journal. 

Uniting all the cases collected by Chomel, Andral, and himself, he finds, that 
in 968 patients 195 had the disease in both lungs, 260 in the left lung, and 413 
in the right; so that for 455 attacks of inflammation of the left side there are 
673 of inflammation in the right. Various explanations have been proposed of 
this fact Some have ascribed its occurrence, more especially in young children, to 
the right being the side on which most individuals lie in jjed; though how this 
circumstance should have the effect of predisposing to pneumonia we confess 
it is not easy to perceive. Others have ascribed it to the greater muscularity of 
the right side of the body; but this explanation is evidently inadequate, since 
M. Lombard clearly establishes that the difference between the two sides in 
liability to inflammation is at least as great in females as in males, and in young 
children as in adults. M. Lombard, on the other hand, considers that the ex- 
planation ought rather to be sought for in the anatomical structure of the or- 
gans; and he thinks that the difference in the size of the arteries sent to each 
side will account for the fact. "After the pulmonary artery," says he "has 
crossed the direction of the aorta, and has reached the level of the second dor- 
sal vertebra, it divides into two branches, of which the right branch is the 



Pathology. 203 

larger and more directly transverse in its course, so that more blood must pass 
along" it than along the left division in the same interval of time. The functional 
activity of the right lung is therefore greater than of the left lung; and it is well 
known that the frequency of inflammation is in the direct ratio of the functional 
activity of the organ. Such at least is the only plausible hypothesis which can 
be formed in the present state of science." 

Several late authors have thought that pneumonia is more frequent in adults 
than in the young. But M. Lombard has been led to a different conclusion; 
which is, that it is most frequent in infancy, and in old age, and least frequent 
in the prime of life. The data on which he rests this statement are taken from 
various pubhc hospitals. From the pathological examination of 206 infants be- 
tween one day and eighteen months old, of 118 children between eightesn 
months and fourteen years, and of 1284 persons of different ages between fif- 
teen and eighty-three, he infers, that pneumonia forms 3-17ths of all the orga- 
nic derangements found in infants, who have died during the first eight days — 
that in the second week it forms 2-9ths — in the third week 3-lOths — between 
the sixth week and the end of the second month 2-9ths — between the second 
and sixth month 1-lOth only. In the second year it increases again to l-3d; from 
the second to the sixth year it forms between a fourth and a fifth; from the 
eighth to the eleventh between a fourth and a sixth; from the fourteenth to the 
nineteenth only l-37th; from the nineteenth to the twenty-seventh about a 
ninth. Prom this period till the age of forty-seven the proportion is only a fif- 
teenth; from this till the age of seventy -five a fourteenth, and above this an 
eighth. 

18. Aneurism of the Right Auricle wUhout Jugular Pulsation. — It is believed 
by some pathologists, that pulsation of the jugular veins is always present in 
cases of aneurism of the right auricle. Mr. Badham, however, of Glasgow, re- 
lates in the London Medical Gazette, for May last, an instance of hypertrophy, 
with dilatation of the right auricle, in which this symptom was not exhibited. 
The subject of this case was a man of seventy-five, of strong constitution, who 
died of dropsy. The right auricle was enlarged to twice its natural capacity 
and thickened, and the ventricle of the same side was moderately dilated; 
the left auricle was similarly affected with the right and to the same extent, 
but there was no valvular disease, or narrowing of any of the cardiac orifices, 
and the left ventricle was quite healthy. This case is further interesting, not 
only from dilatation of the auricles being a rare disease, but also as disproving 
the assertion of Laennec, that it is the consequence of disease of the corres- 
ponding ventricle, or of the valves. 

19. Case of Hydrothorax in a Child fifteen months old. — M. Lichtenstadt re- 
lates in a late No. oi Hecker^s Annales, the case of a child fifteen months of age, 
and well-formed, who, without any appreciable cause, w^as suddenly attacked 
with oppression of the chest and great anxiety; strong and irregular throbbing 
of the heart; inability to remain in a horizontal position. The little patient 
died in a few hours. Upon dissection, both sides of the chest were completely 
filled with a limpid fluid; there was also a similar effusion within the pericar- 
dium. Neither the pleura nor the pericardium presented any signs of inflam- 
mation. Nothing remarkable was observed in any other part of the body. 

20. Enormous dilatation of the biliary ducts. — M. Berakd has met with a case 
in which the bihary ducts were enlarged from twelve to fifteen times their na- 
tural size in the parenchyma of the liver. The patient had neither icterus nor 
obliteration of the ductus choledocus, but the biliary ducts contained many 
calculi. — Mev. Med. May and June, 1831. 

21. Rupture of the Liver and Heart from a fall. — M. Dehan-ne has communi- 
cated to the Anatomical Society of Paris, the case of a woman who died in 



204 QUARTERLY PERISCOPE. 

consequence of a fall from an elevated place. On examination the surface of 
the liver was found torn in many places, the tissue separating the two auricles 
of the heart, broken; and the left auricle torn to the extent of some lines. — 
Rev, Med. June, 1831. 

22. Fatal Haematemesis. — M. Richard has met with a case of hsematemesis in 
a young- man addicted, since infancy, to the use of spirituous hquor, which 
proved speedily fatal. On examination, an ulcer was found near the cardiac 
orifice of the stomach, at the base of which the coronary artery of that organ 
was observed, opened by erosion, and from which of course the blood had flow- 
ed. — Ibid. 

23. Diffused Gangrene of the Lungs. — Of this disease, Laenijec met with but 
two instances, and therefore supposed it to be of rarer occurrence than it would 
seem to be from the researches of subsequent pathologists. During the past 
year M. Bergeon communicated to the Anatomical Society of Paris, three cases 
of it. Five or six cases of circumscribed gangrene of the same organs, have 
also been related to that Society. 

M. Cruveilhier considers as one of the pathognomonic signs of this disease, the 
expectoration of extremely foetid sputa, sometimes mixed with blood, superven- 
ing shortly after symptoms of acute pneumonia. — Ibid. 

24. Melanosis. — M. Cruveilhier has, several times last winter, met with a 
peculiar species of this disease in the lungs. A specimen exhibited to the Ana- 
tomical Society of Paris, presented a filtration of a grayish-black colour, occu- 
pying a considerable extent of the lungs; in the infiltrated parts, the parenchyma 
of the organ was softened, pultaceous, reduced to a vascular net-work, and very 
readily tearable. — Ibid. 

25. On Obliteration of the Veins as the Cause of (Edema or Partial Dropsy, 
particularly in the Lower Extremities. — Some very interesting observations on 
this subject, by M. Corbitst, Physician to La Charite, are inserted in the Archives 
Generates, for April last. Various authors have indicated obstruction of the 
veins as the cause of certain partial dropsies, but the experiments of MM. Rayer 
and Bricheteau, who tied the principal venous trunks without any effusion be- 
ing produced, seemed to have raised some doubts whether obstruction of the 
veins did in general give rise to dropsy. M. Bouillaud, in two valuable memoirs 
in the Archives for 1823 and 1824, completely established the fact, that dropsy 
does sometimes depend upon this cause, and he adduces cases in which ob- 
struction of the abdominal vena cava gave rise to oedema of both lower extre- 
mities; obstruction of one iliac or femoral vein, to infdtration of one limb; that 
of the vena porta, to ascites; of the superior cava or of the larger trunks which 
join it on the right or left side, to infiltration of the whole face and upper ex- 
tremities, or to one-half of the face and one arm. In this theory, Mr. B. includes 
passive dropsies alone, and not phlegmasia dolens. 

M. Corbin's object is to illustrate one point only of this question, viz. where 
one inferior extremity alone is infiltrated, or a great deal more infiltrated than 
the other. Mr. C. has collected twenty cases in illustration of this point, seven 
of which he relates, and he thinks that they establish the proposition, that when 
one limb is infiltrated to a certain degree, and for a length of time, there is al- 
ways a material obstacle to the circulation of the blood through the veins in 
that hmb. Passive infiltrations, it must be remembered, alone are here referred 
to, and not phlegmasia dolens, nor that infiltration which coexists with certain 
erysipelatous inflammations, or that which follows these and other exanthema- 
tous diseases. Mr. C. states, that as far as his experience extends, it would not 
be justifiable to refer these last forms of oedema to obstruction of the veins, 
though future experience may show that they also are induced by the same 
cause. 



Pathology. 205 

Our readers know that M. Velpeau, Dr. Lee, and others, attribute phleg- 
masia dolens to obstructions in the iliac veins, and have adduced some facts in 
support of that opinion. We look upon this point, however, as yet unsettled. 

The obstacle which impedes the circulation of the blood in the veins, may- 
be of various kinds. Thus, a tumour situated in the course of the vessels, or 
the impregnated uterus, may produce the same effect as sanguineous concre- 
tions formed in the vessels, but most commonly it is these last that we find to 
be the cause of the obstruction. 

26. Remarkable Case of Dropsy. — Mr. Fothekgill, of Selby, relates in the 
North of England Medical and SurgicalJournal, for November, 1830, a case of 
dropsy occurring in a married lady, twenty-two years of age. This patient was 
attacked in 1813 with pain in the abdomen, and in the region of the kidneys, 
accompanied with that kind of constitutional irritation which usually attends 
diseases of the uterus. Her general health suffered, and the digestive organs 
were ^considerably disordered. The operation of paracentesis was had recourse 
to for the first time on the 11th of October, 1815, and between this and the 5th 
of December, 1828, it was performed one hundred and fifteen times, and up- 
wards of seven hundred and ninety -four gallons of water drawn off. The pa- 
tient died on the 11th of December, 1828. On examination, her uterus was 
found enormously enlarged, and full of hydatids. 

27. Case of Momentary Suspension of Muscular Contractility and Sensibility — 
Disease of the Superior longitudinal iSinus. — M. Gintrac, of Bordeaux, in an 
interesting volume of memoirs and cases recently published by him, relates a 
very curious case of a child four years of age, who was subject to attacks of 
momentary suspension of voluntary motion. These attacks came on suddenly, 
without premonition, sometimes occurring whilst the child was playing; at 
others when she was in bed. They were not preceded or accompanied with 
any spasms or frothing at the mouth. The child suddenly lost, in severe at- 
tacks, all power over the muscular actions, and if standing, fell down, or if 
lying, became incapable of motion. The sensibility was also diminished. The 
senses were slightly weakened, but was still seaeiblc to external impressions. 
The eyes were open and immoveable; her hearing was preserved; she also re- 
tained in part her intellectual faculties. In slight attacks she would endeavour 
to perform muscular movements, generally in vain. Thus, when food was 
presented to her, she would endeavour to take it, and would fret and cry at not 
succeeding. The duration of the attack v/as variable; it rarely however con- 
tinued longer than a quarter of an hour. The intervals between the attacks 
was also very variable. Sometimes she had several paroxysms in a day, at 
others there was an interval between them of two weeks. 

This patient died in 1828 of measles, and on post mortem examination, the 
principal abnormal structure found, was in the superior longitudinal sinus, be- 
neath the sagittal suture. Its parietes were thickened, dense, and yellow; they 
resisted and crepitated under the knife, they were distended by a sort of black- 
ish coagulum, in the centre of which more fluid blood was found. Between 
the coagulum and the parietes of the sinus, there was a yellowish concretion, 
of a fibrous appearance, and of near a line in thickness. The internal mem- 
brane of the sinus was redder than common, and presented, in a very marked de- 
gree, the reticulated structure, which it commonly possesses; there was no other 
contraction in the remainder of this sinus. The other sinuses were slightly en- 
gorged; the cerebral vessels were somewhat engorged, especially in the upper 
and right portion of the brain, and in the vicinity of the diseased sinus. — .Archives 
Generates, May, 1831. 

28. Pathology of Erysipelas. — One of the late numbers of the Journal Comple- 
mentaire, contains some interesting remarks, by Dr. Corbik, illustrative of the 
history of erysipelas. As we do not receive that Journal, we transfer to our 



206 QUARTERLY PERISCOPE. 

pages the following' notice of Dr. Corbin's memoir, from the London Medical 
and Physical Journal. 

" The principal objects Dr. Corbin has in view, are to offer a few comments 
upon certain forms of erysipelas which appear to deserve especial attention; to 
describe the state of the gastro-intestinal mucous membrane, in a certain num- 
ber of persons who died of the disease; and also to adduce some examples in 
which erysipelas exerted a remarkable influence over other concomitant mala- 
dies. 

*' Phleg'monous erysipelas is frequently complicated with gangrene, but the 
latter condition arises in different ways. Mortification of the skin is g-enerally 
consecutive to destruction of the subcutaneous cellular tissue: and in this case 
we can detect, before g-angrene takes place, some sig-ns of fluctuation, and, if 
the disease be abandoned to its course, ulceration occurs, and shreds of the cel- 
lular tissue, ming-led with pus, are discharged; the external integuments are 
destroyed, and the muscles or aponeuroses are laid bare. In such instances, 
free incisions, if made at an early period of the disease, may prevent mortifica- 
tion, and, if at a later stage, they may limit its extension. The parts do not 
assume a black appearance, nor is there any gangrenous odour. In other, and 
less common cases, to which alone ought to be applied the term of gangrenous 
erysipelas, the gangrene commences in the skin, and is preceded by the appear- 
ance of phlyctxnse, or by the black and livid tint, and peculiar odour, of this 
class of disease. Here incisions have always appeared useless, and when they 
have been made, the edges of the wounds suffered more from gangrene than 
the other parts. Erysipelas of this last mentioned species is usually very se- 
vere: it is characterized from the commencement by prostration of strength, 
and is almost always quickly fatal. Such cases are, fortunately, rare. Thus, 
in erysipelas of the limbs, in nine cases out of ten, gangrene takes place after 
iLv^ suppuration and destruction of tlie cellular tissue. We frequently see pure 
phiegmonous erysipelas arise in the scrotum, and a part of it destroyed by mor- 
tification. Upon the face and hairy scalp, gangrenous erysipelas (confining the 
term to its proper limits,) is rarely seen; and when it does occur, the skin al- 
ways mortifies after suppuration of the subcutaneous cellular tissue. This fact 
is illustrated by the following- case, which is also interesting in some other re- 
spects. 

" A man, forty-eight years of age, after having drank very hard, received a 
sabre wound, three inches long, upon the left parietal bone. He was admitted 
the next day, (March 3d,) into the Hotel Dieu. Attempts had already been 
made to promote the immediate relinion of the divided parts, although, from 
the appearance of the wound, they were not likely to succeed. The adhesive 
plasters, which had been employed, were removed, and the lips of the wound 
were separated: the bone was not exposed, but at the anterior part of the 
wound, which approached the coronal suture, the fibres of the aponeurosis of 
the occipito-frontahs muscle were denuded. The edges of the wound were laid 
very gently together, and, as erysipelas was at that time very common, cold lo- 
tions were ordered, and twenty leeches were applied to the neck. 

" On the 4th, the face was rather swollen. 

*« 5th. Shght erysipelatous appearance on the right eye. , Cold lotions con- 
tinued; blister to the neck. The erysipelas continued to extend, but before it 
had reached its highest degree of severity, it disappeared entirely. 

*' On the 9th, there was seen at the bottom of the wound a yellow-looking 
substance, which was found to be the aponeurosis already mortified. The pa- 
tient complained of being dull and heavy, and of a sensation of weight in the 
head, which was so painful that he could scarcely bear to rest upon his pillow. 

" 11th. Manifest fluctuation at the back part of the scalp, and extensive se- 
paration of the scalp from the bones. The abscess was opened, and a small 
quantity of pus was discharged. Much relief followed, and the following days 
no remarkable symptoms occurred. Mortification of the aponeurosis still con- 
tinued, and shreds of yellowish-looking fibres were, from time to time, separated 



Pathology. 207 

from It. The patient still continued drowsy, but could obtain no sound sleep. 
Inflammation of the membranes of the brain, with violent fever, convulsions, 
and great prostration of strength, soon came on, and the patient sank, and died 
in a few days. 

" Upon dissection, the lung's were found engorged with blood, and appear- 
ances of chronic gastro-enteritic inflammation were detected. Upon the out- 
side and upper part of the cranium, the cellular tissue between the bones and 
the aponeurosis was entirely destroyed. The surface of the bones was covered 
with a sanious discharge, and exfoliation of them had commenced. The pia 
mater was inflamed and thickened, and between this membrane and the arach- 
noid there was an effusion of pus. 

"This case is remarkable, not only on account of the progress of the erysi- 
pelatous inflammation, but it shews also that a wound on the head may remain 
open, although the bones are not denuded. If the occipito-frontal aponeurosis 
is exposed, it exfoliates like a tendon, and often in a very gradual manner. 

"Cases of erysipelas are occasionally seen, which appear to be intermediate 
between the superficial and phlegmonous forms of the disease. In such in- 
stances, there is but little swelling, no collection of matter, to any great ex- 
tent, under the skin, but here and there small insulated abscesses. In a patient 
named Mainvielle, after an attack of erysipelas of the face and scalp, several 
small abscesses formed in the neck, behind the ears, and upon the cranium. 
In another patient, after a similar attack, accompanied with enormous swelling 
of the face and scalp, an abscess formed upon the right upper eyelid, and nu- 
merous small collections of matter, from the size of a filbert to that of a cherry- 
stone, also formed upon the scalp. These abscesses remained for a long time 
very hard; some of them disappeared spontaneously, and others were opened, 
and healthy pus was discharged from them, 

*' External erysipelas frequently disappears from one part, while at the same 
time the disease attacks a more or less distant region of the body. Thus, in a 
man named Tessier, who was admitted into the Hotel Dieu, erysipelas of the leg 
and foot disappeared when the face became the seat of the disease, and the 
parts originally aflTected were again attacked when the face recovered. Ery- 
sipelas also frequently exercises a revulsive influence upon internal diseases. 
A young man was attacked with acute pulmonary catarrh: he was bled fre- 
quently, but without decided advantage; he was much oppressed, skin hot, 
pulse hard and quick. He was attacked with erysipelas of the nose, which 
quickly extended to the face and scalp. The feverish symptoms increased, 
and he became delirious. Leeches were applied to the neck, and he was bled 
in the foot; in a few days the erysipelas disappeared. From the time that the 
external inflammation appeared, and while it lasted, the patient breathed 
freely; there was less expectoration, and, in fact, there was every reason to 
believe that the bronchitic affection had ceased. It might at first have been 
presumed that this diminution of the symptoms depended as much upon the re- 
peated abstraction of blood, as upon any revulsive influence of the external in- 
flammation: but no sooner had the erysipelas ceased, than the cough, oppress- 
ed breathing, and other indications of bronchitis, reappeared with increased 
severity, and it was again necessary to have recourse to venesection. 

Phlegmonous erysipelas of the lower extremities, of the most severe kinds, 
is very often produced by the slightest external causes: either from excoria- 
tions, slight wounds, the neglect of old ulcers, or by applying stimulating re- 
medies to them; and sometimes simple contusions are sufficient to produce the 
disease, as in a man named Wivet, among other similar instances, who died in 
three days of erysipelas, in consequence of falhng upon his knee. Sometimes 
no external cause can be detected. 

When we oppose to these cases numerous instances of other patients, placed 
in the same circumstances, or even affected, during the same season, with much 
more severe external lesions, and in whom, notwithstanding, no erysipelatous 
disease is developed, we must presume that, in the former, there existed some 



208 QUARTERLY PERISCOPE. 

peculiar disposition, or, to speak less vaguely, a lesion of some Important of" 
g-an, and particularly of the abdominal viscera. The idea is confirmed when 
we detect a red and dry tongue, head-ache, sensibility in the epigastrium, an 
inflated state of the belly, diarrhoea, or enlargementof the liver: but the results 
of dissection in eleven fatal cases of erysipelas, afford the most satisfactory proof 
of the accuracy of this opinion. 

" In the first, a patient named Tupin, the mucous membrane of the stomach 
was nearly of a black colour, and softened throughout the region of the pylo- 
rus: the commencement of the duodenum exhibited the same appearances. 
Almost the whole of the small intestines, to within an inch above the coscum, 
was of a deep violet colour. In the large intestines, some of the glands were 
hypertrophied, and appeared like small pustules. 

'* In the second case, a patient named Pfliig, stomach highly coloured in 
different parts, with patches of a red and brown appearance; the colon, through- 
out its whole extent, of a deep red colour. 

" Case III. Duranton: Appearances of chronic inflammation of the stomach 
and duodenum, characterized by reddish tubercles? rectum distended with 
fxces. 

*' Case IV. Leerbier: Peritoneum of a red colour, with serum. Stomach, 
patches of brown and black colour. Duodenum, a circular ulceration, about 
the size of half a crown. 

" Case V. Scheier: Mucous membrane of the stomach softened, and of a dark 
slate colour; the submucous cellular tissue of the duodenum deeply injected; 
red patches in the coecum. 

"Case VI. Wivet: The mucous membrane of the stomach and duodenum 
softened, and of a gray colour, throughout nearly its whole extent. 

" Case VII. Debry: In the stomach, near the cardiac orifice, was found a 
smooth hollow tumour, the size of a small renette apple, containing bloody 
serum. The whole surface of the stomach of a dark colour. 

*' Case VIII. Tronnet: The mucous membrane of the stomach softened, and 
generally pale; small red spots on the great curvature. 

"Case IX. Lefebre: Liver studded with gray tubercles; spleen softened, 
and of a large size. 

*' Case X. Lambert: The mucous membrane of the stomach of a deep slate 
colour. 

" Case XI, Delgutte: Biliary calculi were found. 

" Thus, with the exception of the last two cases, in which no striking mor- 
bid appearances were detected, in all the bodies there were considerable le 
sions of the abdominal organs. If we compare these results with our observa- 
tions during life, it will be difficult to deny that most cases of erysipelas depend 
upon some internal cause. If such be the most frequent cause of erysipelatous 
diseases, it may appear singular to attribute to these maladies a decided influ- 
ence over the progress of internal inflammations. This influence is, however, 
very evident, and not more astonishing than other revulsions effected by nature 
or art. No fact is better ascertained than this kind of antagonism, which is es- 
tabhshed, in certain cases, between the skin and internal mucous membranes, 
and especially the gastro-intestinal. Hence the use of purgatives and emetics 
in the treatment of erysipelas: but these means should only be employed when 
the digestive powers are healthy, or at least when there is simple obstruction 
of the stomach and bowels. In similar instances to those above-described, we 
must, it is true, act principally upon the abdominal organs, but antiphlogistic 
and emollient remedies can alone be employed with safety." 

29. Amnesia. — M. Cassan has communicated to the Royal Academy of Me- 
dicine of Paris, the following interesting case of cerebral disease with the los» 
of memory of words. A man was attacked with hemiplegia, which was relieved 
by bleeding and blistering. Shortly afterwards he experienced incipient amau- 



Pathology, 209 

rosis in both eyes with pain in the head and noise in his ears. After some time 
hemipleg-ia returned. The patient then lost the memory of words, so that he 
could not name the commonest things; his mind in other respects was unim- 
paired, and all the organic functions were properly performed. He could also 
read fluently. He remembered objects, for he drew them upon paper, but he 
forgot the names by which they were called. The sight of a female whom he 
loved excited him and momentarily restored the faculty of language he had 
lost. He complained of insomnia, heaviness of the head, difficulty of muscular 
action, weakness of sight and hearing, &c. 

This case is analogous to that of the notary, recorded by M. Pinel in his no- 
sography, who, after an attack of apoplexy, forgot his own name, that of his 
wife, and of his children, but remembered the places where his clients briefs 
were deposited. M. Larrey has also related an instance of the loss of memory 
of words, following a wound. Professor Broussonet has also recorded an in- 
stance in which there was a loss of memory of substantives, while that of adjec- 
tives was preserved; it followed apoplexy; and a similar case is recorded by Dr. 
Camberet in the Journal Complementaire, for February, 1819. Three analogous 
cases will also be found in this Journal; one by Dr. Jackson, Vol. HI. p. 272, 
another by Dr. Chailly, p. 452 of the same volume, and a third by Professor 
Dickson, Vol. VH. p. 359. This last has the closest resemblance to the case of 
M. Cassan. 

30.' Spinal Irritation. — The subject of spinal irritation has of late attracted 
considerable attention. The following cases related by Mr. Wark, of Dunlop, 
in the Glasgow Medical Journal for May last, tend to throw additional light on 
this very interesting affection. 

Case 1. 3d April, 1826. J. H. Weaver, set. 49, of shattered constitution. 
Complains of dull pain at breast, with incessant cough, almost preventing 
sleep, copious muco-purulent expectoration, dyspnoea, palpitation of heart, 
head-ache, and profuse nocturnal sweats; pulse 95, bowels confined. Has been 
ill four months, and treated with blisters to the breast, and cough mixtures, 
without benefit. Dorsal vertebrae, about 6th, 7th, and 8th, are painful on 
pressure; pain stretching forward to breast, so acutely as to cause him to cry 
out. He had his bowels freely opened with purgative medicine, was confined 
to the horizontal position, and a blister was applied over pained part. 8th 
April. Blister after several applications discharges freely, but has produced a 
good deal of febrile excitement, which is subsiding. 12th. Blistered surfaces 
healed, and all the symptoms mitigated; pain in spine confined to one spot. 
The blister repeated, and kept open about eight days, restored him to his 
usual good health. This patient had been given up for consumption, and cer- 
tainly he bore some marks of phthisis. It appeared, however, to be merely 
chronic bronchitis, combined with spinal irritation. 

Case 2. 22d June, 1828. H. B. set. 21, a woman of stout habit, has been 
subject to cough for several years; for eight or nine months has complained of 
pain in right side of chest, nearly constant, increased on inspiration and cough- 
ing; weight and oppression at breast, difficulty of breathing, dry convulsive 
cough, occasional head-ache, and dullness of spirits. Pulse 90, full, tongue moist, 
bowels natural, cataraenia regular. Was bled to 12 ounces, and had a small 
blister applied to the breast with very little relief. 3d July. Symptoms worse. 
The 3d, 4th, and 5th dorsal vertebrae are tender on pressure, particularly on 
right side, pain stretching acutely forward along the course of the intercostal 
nerves, to pained part inside of chest, causing dreadful convulsive coughing". 
The horizontal position was strictly enjoined, and 12 leeches ordered to pained 
part of spine, which gave immediate relief; this was followed by a small blister 
kept open for a few days. 10th July. Expresses herself greatly relieved, cough 
and other symptoms nearly gone — three leeches more completed the cure. 
About a year and a half afterwards, this girl being attacked with small-pox, the 
same symptoms recurred, but subsided with the fever. 
No. XVII.— Nov. 1831. 19 



210 QUARTERLY PERISCOPE^ 

Case 3. 5th June, 1829. Mrs. A. set. 33, mother of six children, of delicate 
constitution, complains of intense pain of right side of head, which appears a 
little swollen, dry cough, pain and oppression at breast, little increased on deep 
inspiration? respiration hurried and laborious, pain and numbness about 
shoulders, stretching down arms, palpitation of heart, great debility, is 
fatigued on the shghtest exertion, or even speaking; pulse 112, weak and 
irritable, bowels costive. Upper dorsal and lower cervical vertebrae are 
painful on pressure, most severe about 3d and 4th dorsal; pressure aggravating 
symptoms. Had a child about three months ago, and did not recover well; 
three weeks afterwards was affected with violent pain at breast, for which she 
was three times bled, and as often blistered, with but partial rehef. Has con- 
sulted three medical men, who uniformly recommended blistering the breast. 
Is much reduced in body, and considered by herself and friends to be consump- 
tive. Three days previous to seeing her, she had come fifty miles by land and 
water for the benefit of sea air, and had caught a cold on her passage, to which 
she attributes the aggravation of her complaints. Day before this, had of her 
own accord, applied twelve leeches to side of head without benefit. She had 
two blue pills at bed-time, followed in the morning by a full dose of salts and 
senna, which procured copious evacuations with abatement of head-ache and 
febrile symptoms. Was ordered twelve leeches to upper part of dorsal verte- 
brae, to be followed by a blister. As she lived a considerable distance from me, 
it was ten days before I again saw her. She was now so much better, that she 
was able to walk about, without fatigue; appetite and strength improving 
every day. Is still suckling her child; says she has not enjoyed such health 
since delivery, and describes her feelings after leeching as if something were 
wanting about her breast; blistered surface has discharged well, but is 
now healed. Pain in spine confined to between 3d and 4th dorsal vertebrae, 
and much easier. Nine leeches, and a small blister about the size of a crown- 
piece kept open about eight days, removed her whole train of symptoms. I saw 
her about four months afterwards with slight return of same complaint, which 
was easily cured by the same treatment. In this case, the horizontal position 
was only enjoined a few days at first. In some cases the horizontal position is 
a sine qua non in the treatment; in others it is by no means essential. 

Case 4. 28th Aug. 1829. I was called to Miss B. ^t. 20, of delicate habit, 
who said she was ashamed to see me, as she could not tell what she had to 
complain of, only she felt weak, and her appetite was gone. Pulse 80, feeble, 
tongue moist, bowels natural, catamenia regular; stoops much, body reduced 
to a skeleton, so dull in spirits that she can scarcely be roused to the least ex- 
ertion. On strict interrogation, admits having a slight feeling of weakness or 
weariness at breast. Upper dorsal vertebrae are tender on pressure, most 
about the fourth on left side; right quite free from pain, pressure aggravating 
symptoms at breast. About six weeks ago, after assisting the maids a short 
time at a washing, her hands and forearms became covered with a florid erup- 
tion, which soon disappeared, and was succeeded by a slight cough and uneasi- 
ness about chest, which have since gradually worn away. Was treated with a 
solution of tart, antim., bark, and other tonics, but without effect. Six leeches 
were ordered to pained part of spine, which procured immediate relief. She 
was now sensible she had been labouring under more oppression at breast 
than she had been aware of. A small blister produced such constitutional de- 
rangement, and aggravated the symptoms so much, that I did not think of re- 
applying it. A few leeches were applied every second day for a while, making 
in all thirty-one, which along with the horizontal position, greater part of the 
day, effected complete recovery. During the application of the leeches she 
uniformly felt herself getting better, symptoms returning a little before next 
application, which gradually wore off towards the end. In less than four weeks 
her health and strength were completely restored. 

Cases. M. C. aet. 23. In summer, 1826, I attended this girl in fever. She 
was advanced in the disease, and had been neglected before I saw her; was 



Pathology. 211 

treated with local bleedings, blistering", emetics, purgatives, &c. as symptoms 
indicated. Her recovery was slow, and accompanied with a host of nervous 
and hysterical symptoms, which have continued more or less ever since. About 
two years ago the abdomen getting enormously distended and communicating 
a doughy feel to the fingers, there was little reason to doubt that her bowels 
were loaded with feculent matter. A course of purgative medicine was ordered, 
which brought away a prodigious quantity of dark pitchy looking faeces, mixed 
with mucus and slimy matter. The belly, however, continued nearly of the 
same size, but a little softer; the stools were less in quantity, but much the 
saaie in appearance. Her strength getting exhausted, and her faith having 
failed her, I was obliged to abandon the practice. About six months after this 
she complained of pain in right hypochondriac region, aggravated on pressure, 
with frequent attacks of bilious vomiting; upon questioning her she admitted 
having pain about shoulders, particularly on right side. Several medical gen- 
tlemen saw her, and she was more than once blistered over the region of the 
liver, and salivated with mercury, to no purpose. 

On the 18th of December, 1829, I was again called to see her. She had been 
getting worse for some months, and is now confined to bed. Complains of pain 
and giddiness of head, pain and numbness about shoulders and arms, particu- 
larly right arm; dull pain over region of liver and abdomen, most acute about 
caput coli, occasionally stretching' down thighs: is much harassed with vomit- 
ing of acrid bile; eyes weak; speech has been hesitating for some months, is 
worse of late, stops often in the middle of words; abdomen reduced to natural 
size and feel; bowels open; pulse eighty, weak; menses have made their ap- 
pearance all along, but a little irregularly. Says she is pretty easy Vvl.ile lying 
in the horizontal position, but all her symptoms are aggravated on getting up: 
gets so faintish in the erect position, that she is soon obliged to lie down. These 
symptoms led me to suspect the spine to be in fault: it was accordingl}' examin- 
ed, and found tender throughout its whole extent, but particularly the cervical, 
lower dorsal, and middle of lumbar vertebrae; pressure, or the application of a 
sponge dipped in hot water, on the lumber vertebrae, gave pain, aggravating 
pain in abdomen, and particularly at caput coli; pain shooting down thighs, 
along the course of crural nerves. On pressing the inferior dorsal, pain 
stretches forward to right hypochondriac region, which she describes as dis- 
tinctly the pain she has so long felt there: pressure on the inferior cervical 
produced a feeling of pain and numbness about shoulders, stretching down 
right arm, which has not had proper feeling for some months: but the most re- 
markable symptom of all is in the upper cervical; slight pressure there in- 
creases the shooting pains over the head, and causes a feeling of constriction 
about the throat, increasing the impediment in speech, and causing difficulty 
of respiration. When the pressure is increased, the pain becomes intolerable, 
the function of voice ceases, and the respiration is as completely stopped as if 
she were suspended by a rope round the neck. Whatever part of the spine 
was pressed on, pain was felt shooting along the course of the nerves, but most 
severe on the right side. The upper cervical and inferior dorsal were the two 
points most severely aflTected, and from which I judged it notunhkely the pain 
might spread along the spine: these I resolved first to attack. Six leeches 
were applied to upper cervical, and same number to lower dorsal vertebrae. 
These were repeated with relief, and two small blisters were afterwards ap- 
plied. In five days, when I again visited her, I found that the leeches had bled 
very freely, and had produced considerable debility: her face was pale and 
blanched, and she could with difficulty turn in bed. The blistered surfaces 
discharged for about a fortnight. It was a month before she gathered much 
strength: these symptoms, however, were mitigated, and she spoke more 
freely. By the beginning of April she was able to be out of bed the greater 
part of the day, spoke without hesitation, and was nearly free from former 
symptoms, but dorsal vertebrae, between ninth and tenth, were still a little ten- 
der, By the middle of June she could take exercise out of doors, had a good 



212 QUARTERLY PERISCOPE. 

appetite; and the spine was sound, except between ninth and tenth dorsal ver- 
tebrae, where there still was tenderness on pressure, shooting- through to right 
side, in which she still felt some uneasiness. Considered herself in better health 
than at any time since attack of fever. 

The horizontal position may have been a good adjunct here, but that it was 
essential to the cure does not appear, as she was obliged to keep it most of the 
time for nearly six weeks before the treatment commenced, notwithstanding 
which she became every day worse. That the origin of the nervous system 
was in fault since fever, I doubt not, and that timely detection and timely 
treatment might have saved her from nearly four years' suffering and misery, 
and preserved her constitution from a shock from which it can never fairly rally, 
I as little doubt. The pain in side and shoulders and vomiting of acrid bile, were 
certainly symptoms of inflammation of the liver, but it is plain it xfAS merely 
suffering in function, from disease of its nerves, as the heart and stomach are 
often known to do from the same cause. 

Case 6. A few weeks ago I was called to see a young woman twenty-one 
years of age, whose prominent symptom was vomiting of every thing she took. 
She had pain in right hypochondriac region, increased on pressure, and pains 
about shoulders, shooting down right arm, which she describes as stitches. Had 
a child in the sixteenth year of her age, from which she dates the commence- 
ment of pain in side; pain in shoulders more recent; dyspepsia of some years' 
standing, but vomiting has only been distressing of late. Has been often bled 
and blistered for pain in side, (supposed to be hepatitis,) and sometimes with 
partial relief. Had consulted a medical practitioner a few days ago, who or- 
dered a large blister to be applied over region of liver. Ninth and tenth dor- 
sal, and fourth, fifth, and sixth cervical vertebrae, are painful on pressure, the 
pain stretching to pained part in side and shoulders. Nine leeches were imme- 
diately applied to ninth and tenth dorsal vertebrae, and, in a few days, same 
mimber to inferior cervical. Eight days after this, she came a distance of about 
four miles, to show me how much improved she was. Vomiting gone, pain in 
the shoulders and side much better, lies in bed most easily on right side, which 
she has not been able to do since she had the child; pained parts in spine still 
a little tender. Leeches ordered to be reapplied. 

I saw her about a week ago, stout in body and looking well. Says that she 
enjoys excellent health, to which she has been a stranger for more than five 
years. The horizontal position was not observed in this case. 

I have only met with one case of this kind which defied remedial measures; 
the prominent symptom was tickling cough: time, however, effected the cure. 
Several cases have been relieved, although they could not be said to be cured. 
This disease sometimes accompanies consumption, yet in one case I had strong- 
reason to believe that it roused up fatal tubercular phthisis. 

That this class of complaints is seldom seen, except in the debilitated walks 
of life, appears to be unfounded. Any thing here, in place of a town, scarcely 
deserves the name of a village. My practice is entirely in the country, in a 
place, too, famous for the salubrity of its air, and the healthiness of its inhabi- 
tants; yet in such a place spinal irritation holds no inconsiderable rank in the 
catalogue of human calamities. 

As a stimulus to the younger candidate for medical eminence, T may be al- 
lowed to mention that, in the diagnosis and treatment of no other disease have 
I gained so much credit and confidence in families. I have cured several who 
have been long considered to be falling victims to consumption, the gaunt and 
unrelenting destroyer of mankind. Restored to the arms of their families and 
friends from a long period of hopeless sufferings, they often know not in what 
terms to express their gratitude. 

31. Ulceration and Perforation of the Heart. — An instance of this is recorded 
in a late number o^ La Lancctte Frangaise. The subject of this case was a fe- 
male fifty-one years of age, admitted into the Hotel Dieu on the 8th of March 



Materia Medica and Pharmacy. 213 

last. She exhibited some obscure gastric symptoms, and could very imperfectly 
describe either the nature or seat of her complaints. Her tongue was pale and 
slightly furred; her pulse regular^ rather more frequent than natural; bowels in- 
active. Her disorder appeared so slight that little attention was paid to her. 
Eleven days after her admission she suddenly died. A short time previous 
she had been tranquilly conversing with her neighbour, and did not make any 
complaint of pain or unusual uneasiness. 

On examination the left ventricle was found perforated at its posterior and 
middle part by an ulcer, or apparently two ulcers, one commencing internally, 
the opposite to it externally; at least the shape of the hole gave that idea, it 
being larger externally and internally than in the centre, and therefore present- 
ing an ho^-glass figure. The fleshy substance of the heart was not softened, 
except ^Wmx short distance around the ulcers. Thick, red, fibrous layers were 
found on both surfaces of the heart. The heart was enlarged, but without any 
thickening of its parietes. The ventricular valves and orifices of the vessels 
were normal. 



MATERIA MEDICA AND PHARMACY. 

32. Comhination of Nitre and Calomel. — M. Bukdach states in a recent Ger- 
man Journal, that the addition of nitrate of potash prevents calomel from pro- 
ducing salivation, the nitre causing its prompt expulsion by stool. This 
combination he also asserts to be a powerful derivative, and relieves the head, 
the chest, and the liver, more effectually than either of them will do separately. 
Certain diseases, as hydrocephalus, croup, &c. he adds, require large doses of 
calomel, and if this medicament is not eliminated from the system, it becomes a 
poisbn: the addition of nitre prevents this unfortunate result. — Gazette M^di- 
cale, Juliji 1831. 

33. Correcter of Opium. — According to M. Pucheit, a German physician, the 
sulphate of soda is an excellent correcter of the unpleasant effects of opium, 
^iven in the proportion of a scruple to half a grain of opium. This dose may be 
repeated two or three times a day. In combination with Glauber's salt, opium 
he says, may be administered in cases where slight plethora, local or general, 
prevents recourse being had to opium alone; in obstinate haemorrhages, prin- 
cipally, this mixture will produce the happiest effects. But if sulphate of soda 
prevents the congestion which opium sometimes produces, M. P. says that 
there is another article which corrects its narcotic, without diminishing its se- 
dative, effects — this is the castor. The combination of opium and castor he con- 
siders very useful in cases of hysteria. — Ibid. 

34. New Process for preparing Medicinal Prussic Acid. — Mr. Thomas Clabk, 
describes in the Glasgow Medical Journal ^ov May last, the following process for 
preparing Medicinal Prussic Acid, by which, he says, that every Apothecary 
may make that article cheaply, and of uniform strength. 

"Take of Tartaric acid, 72 grains; Cyanide of potassium, 32 do.; Distilled 
water, an ounce. — In an ounce phial, furnished with a cork or stopper, which 
should, by previous examination, be ascertained to be sufficient, dissolve the 
tartaric acid in the water. Then add the cyanide of potassium, and immediately 
thereafter insert the cork or stopper, which for a little must be preserved firmly 
in its situation by the finger. Meanwhile agitate, keeping the phial immersed 
in a basin of cold water, in order to repress the heat produced in the process. 
"When all action has ceased, set the phial aside in a cool and dark place for 
twelve hours, in order that the cream of tartar formed may subside. After- 
wards decant the liquor, which preserve in a phial in a cool and dark place. '* 

Those who are accustomed to chemical calculations, will easily perceive that 

19* 



214 QUARTERLY PERISCOPE. 

the following result ensues: — We employ Tartaric acid, 72 grains ; Cyanide of 
potassium, 32 do. Total, 104 grains. — These produce. Cream of tartar, 91 
grains; Hydrocyanic acid, 13 do. Total, 104 grains. 

But an ounce of water dissolves no more than about five grains of cream of 
tartar; and its soluble power is likely to be diminished by the presence of hy- 
drocyanic acid. Therefore all the cream of tartar formed, except five grains, 
that is, 86 grains, will subside ; and the water will hold in solution, besides 
those five grains of cream of tartar, 13 grains of hydrocyanic acid. But this so- 
lution will contain about 26 full doses (we will say 25) of hydrocyanic acid. Of 
cream of tartar, therefore, each dose will contain only 5.25, or one-fifth of a 
grain. The presence of this small quantity of cream of tartar would be regarded 
as an impurity by chemists, who would separate it by distillation. B|^, little re- 
gard will the physician give to the presence of cream of tartar, aSrounting to 
the fifth of a grain in a dose. In employing prussic acid, indeed, the objects 
of the chemist and of the physician are altogether different. Purity is the de- 
sire of the chemist ; uniformity of strength that of the physician. A disregard 
of this difference has too often in pharmaceutical processes caused chemical 
purity to be dearly purchased at the expense of medicinal uniformity. 

"In the above process, provided we retain the same quantities of tartaric acid 
and of cyanide of potassium., it is plain that, by varying the water, we may ob- 
tain a solution of prussic acid of any given strength. The above formula is 
adapted to the strength suggested by Vauquelin, namely, water one ounce, to 
the prussic acid which may be obtained from one drachm of cyanide of mer- 
cury; for this yields the same quantity of that acid as 32 grains of cyanide of po- 
tassium. This strength of Vauquelin is thai most generally in use in this 
country ; and it has been adopted in the last edition of the Dublin Pharmaco- 
poeia. Magendie's solution of prussic acid is about four times as strong. 

*« In the common processes for preparing prussic acid, one great cause of the 
various strengths produced by those processes, is the great volatility of prussic 
acid. To be aware of the great risk of loss by this volatility, put a drop of a 
solution of pure hydrocyanic acid on a bit of litmus paper. This paper will be 
immediately reddened, as by any other acid ; but, so very volatile is this acid, 
that the redness will vanish in two or three minutes, ere the drop has visibly 
diminished in size. But the solution will be affected in its strength by this 
volatility of the acid, not merely according to the manner in which it is pre- 
pared, but also according to the manner in which it is preserved. Here, the 
volatility being too little feared, is too little guarded against. I would enforce, 
therefore, great care as to the sufficiency of the cork or stopper; and the pre- 
caution of inverting the phial is worthy of adoption. The further precautions 
of excluding light and avoiding heat are necessary to prevent a spontaneous 
decomposition which prussic acid sometimes undergoes." 

35. loduret of Lead. — From the experiments of Drs. Cotteheau and Vekde 
DEiiisiE, made at the hopital de la Pitie, in the wards of M. Velpeatj, it appears, 
that of all the preparations of iodine, the ioduret of lead possesses, in the high- 
est degree, the property of resolving scrofulous and scirrhous engorgements. — 
Journal Hebdomadaire, liprily 1831. 

36. Solution of Cantharides. — Sir Charles Scudamore recommends as a substi- 
tute for the common blister, a solution of cantharides in concentrated acetic 
acid. This solution is rubbed on the surface of the part which it is wished to 
vesicate, with a small varnishing brush, for about two minutes, or until a slight 
flush of redness is perceived. In less than the usual time, free vesication is 
produced, and a copious discharge of serum follows. — London Medical Gazette^ 
June, 1831. 

37. FormulsefortheexhibitionqfHi/driodateoflron. — For a Bath. R- Hydriod. 
ferri, §ij. aquae, q. s. M. The quantity to be progressively increased, for adults, by 



Materia Medica and Pharmacy. 215 

half an ounce at a time.— J^or Lotions, Injections, &c. R • Hydriod. Ferrl, § ss. Aquae 
Distillat. Ibij. M..—For Pastiks. R. Hydriod. Ferri, ^j. Croci Stigmat. gviii. Sac- 
chari, ^viii. Gum Tragacanth, q. s. Fiant Pastil. 240. Eig-ht or ten to be taken in 
the course of twenty -four hours, and the dose augmented by one every three or 
four days. They are recommended in enlargement of the cervical glands, in 
chlorosis, and particularly in amenorrhoea. — For Ointment. R. Hydriod. Ferri, 
^iss. Adipis, gj. M. The size of a small nut to be used night and morning, 
rubbed into the thighs, in amenorrhoea and in leucorrhoea. — For Tincture. R, 
Hydriod. Ferri, 51 j. Alcohol. Camphorae, aa. ^ij. M. — For Wine. R. Hydriod. 
Ferri, ^ivss. Vini f Bordeaux J ifej. M. A table-spoonful to be taken night 
and morning by adults, in scrofulous affections, &;c. — Lon. Med. Gaz. Aug. 1831. 

38. Medicinal Properties of the Sulphuret of Carbon. — The sulphuret of carbon, 
though discovered by Lampadius, in 1796, has not yet been introduced into 
the medical dispensatories. MM. Wutzer and Pellengham have lately investi- 
gated its properties with the following results: — 

1. The sulphuret of carbon is one of the most powerful of the diffusible sti- 
mulants yet discovered. 

2. It excites powerfully the activity of the heart and arterial system. 

3. Its internal use quickly determines acceleration of the pulse, increased 
heat, and sanguineous congestion towards the skin, and genito-urinary appa- 
ratus. 

4. The most remarkable secondary symptoms are, abundant diaphoresis, in- 
crease of the urinary secretion and of the menstrual discharge. 

5. It has been used with the utmost success as a remedy in chronic rheuma- 
tism, and in gout where no fever simultaneously exists. 

6. The dose in which it is fit to give it internally, is from three to eight 
drops, in any convenient liquid vehicle, or on a bit of sugar. It is also very 
useful as a liniment, which may be formed with sulphuret of carbon, ^ij. and 
camphorated alcohol, §iv.; olive oil may perhaps be advantageously substituted 
for the camphor solution. — Journal de Chimie. 

39. Formula for Nitrate of Silver Ointment. — The following is the formula 
given by Mr. Middlemoke for this ointment: — R. Argent, nitratis, gr. ij.; Liq. 
plumb, acetatis, gtt. xv. ; Ung. cetacei, ^j. M. The quantity of nitrate of silver 
may be gradually increased to six or even seven grains, as the eye becomes ac- 
customed to its use. It is highly important that this ointment should be care- 
fully prepared, and that the various substances of which it is composed, should 
be accurately blended; and that the nitrate of silver should be reduced to an 
impalpable powder before it is mixed with the spermaceti ointment. The oint- 
ment should not be used after it has been prepared for a longer period than 
twelve or fourteen days. 

Mr. Middlemore directs the ointment to be applied in the following manner. 
Having placed a portion of the ointment, about as large as a small split pea, 
upon the blunt extremity of a probe, take hold of a few of the eyelashes, and a 
portion of the surrounding skin, and elevate and slightly evert the upper lid; 
then direct the patient to look downwards, smear the ointment upon the upper 
part of the eyeball, and withdraw the probe on the temporal side of the eye; in 
this way the ointment becomes thoroughly dissolved, and equally diffused over 
the whole of the corneal surface. 

Mr. M. employs this ointment in various affections of the eye. — Midland Me- 
dical and Surgical Reporter, August, 1831. 

40. Asparagus as a Sedative. — The Gazette Medicate of the 28th of May last, con- 
tains a memoir by M. Eusebe be Saele, on this subject. The attention of the 
profession was first called to the sedative properties of asparagus by M. Broua- 
sais about two years since. (See this Journal, Vol. V. p. 499.) The diuretic 
property of this vegetable is known to every one; M. de Salle attributes to it 



216 QUARTERLY PERISCOPE. 

another, which we confess never to have observed. He says that it ex- 
cites, in persons whose larynx is susceptible, in half an hour or an hour after 
it is eaten, a violent constriction of the throat; there is a considerable irritation 
of the larynx, and the g-lottis has a tendency to spasmodic contraction. This 
painful state ordinarily ceases in about twenty minutes. For a knowledge of 
its calming" property, we are indebted to a gentleman, not of the profession, af- 
fected with a chronic irritation of the heart, and who observed that he suffered 
much less after eating asparagus. As this vegetable could be obtained but for 
a short season, this gentleman applied to M. Johnson to prepare for him a sy- 
rup, which he might take when the plant was not to be procured. M. John- 
son, anxious to obtain, in an isolated state, the active principle of the vegeta- 
ble, undertook, with the aid of MM. Vauquelin and Robiquet, its analysis. He 
ascertained that the constituent principles of the asparagus, are asparagine, a 
green resinous matter, wax, albumen, phosphate and acetate of potass, and 
finally, mannite. Upon experiment, the asparagine was found diuretic, but not 
sedative, and the green resin slightly sedative; the combination, however, of 
the asparagine and the green resin was found most efficacious. 

In our seventh volume, p. 232, we pubhshed the method recommended by 
Chevallier for preparing the syrup of the asparagus; the following is that em- 
ployed by M. Johnson: — Take eight pounds of asparagus, cut it in small pieces, 
bruise it, and express the juice by a strong pressure. Evaporate the juice to a 
syrupy consistence, then allow the asparagine to crystallize; decant, and again 
evaporate the liquid to a dry extract. 

Take the green part of the asparagus shoots, and macerate them for fifteen 
days in half their weight of alcohol, at 22°. Express, and take enough of it to 
entirely dissolve the dry extract; when the extract is dissolved, evaporate, to 
remove from it the alcohol. Use this to dissolve the asparagine, and then make 
the syrup. 

We hope that some of our pharmaceutists will undertake to investigate the 
active principles of this plant, and the best mode of obtaining it, and will form 
a preparation of it, to enable physicians in this country to determine its thera- 
peutic properties. If it really possesses those attributed to it, there are many 
cases in which it is calculated to afford important relief. M. de Salle relates 
two cases of distressing palpitation of the heart, in which the most manifest re- 
lief followed its administration. 



PRACTICE OF MEDICINE. 

41. Treatment of Croup. — In the second number of our esteemed cotempo- 
rary, the North of England Medical and SurgicalJournal, there is an interesting 
paper on the treatment of Croup, by W. Goodlad, Esq. of Bury, and as the 
author's views differ in several points from those usually received, we shall lay 
an account of them before our readers. 

When effusion has taken place in this disease which may be known by a rat- 
tling respiration, with disposition to sleep, pale or livid lips, and cold extremi- 
ties, Mr. G. says that death must follow, and that it will be accelerated by the 
remedial, means we should otherwise employ. "But so long," he says, "as 
the attack is accompanied with a high sounding cough, without rattling, the 
mischief whatever it may be, is not irremediable; I would go much further, and 
declare it ought to be arrested, and feel a perfect conviction, in the majority of 
cases, that it may. 

*' I am aware that there are instances on record, where death has taken place, 
though no effusion could be discovered afterwards. These cases probably gave 
rise to the doctrine of spasm, regulated the treatment in many cases, and still are 
quoted with more observance than they appear to me to deserve. But grant- 
ing their validity, it has not yet been proved that a more active treatment 



Practice of Medicine, 217 

would not have saved life; nor is death, under such circumstances, a common 
occurrence, where no remedies have been used. Among-st the poorer classes in 
Lancashire, who seldom call in assistance for croup, until all chance of reco- 
very is destroyed, I have never jet seen a case terminate fatally, without an ef- 
fusion in the bronchia being" conspicuous several hours before death; and I am 
much disposed to attribute such an event where it has happened, to the reme- 
dies made use of, rather than consider it a natural termination of the disease; 
particularly as some of those commonly in use are well calculated to produce it. 
" Am.ongst these," he adds, " the warm bath is one of the most active, and, at 
the same time, most injurious; and I cannot imagine how any one, who has 
once witnessed its effects, can again recommend it in croup. It is, in my opi- 
nion, so decidedly hurtful, by quickening the circulation, thati should interdict 
its use in almost all inflammatory cases. The warm bath, I think, is never use- 
ful unless prolonged until faintness is produced; and in the early stages of in- 
flammatory complaints, it is often impossible to produce this effect, until the 
heart beats more than 130 times in a minute, which is a degree of excitement I 
think unwarrantable. If resorted to later, effusion is brought on sooner than it 
would otherwise supervene; and many practitioners could, I think, call to mind 
cases, where its use has been followed by unexpected death: the vessels previ- 
ously emptied perhaps by bleeding, having given way, and apoplexy super- 
vened." 

Emetics are equally condemned by Mr. G. " The action of vomiting con- 
sists," says Mr. G. " not merely in ejecting the contents of the stomach, for res- 
piration is suspended by it, whilst the heart continues to act, and by propelling 
blood to the lungs, the balance between these functions is so far destroyed, that 
the greatest muscular exertions become necessary to restore it. These strug- 
gles are more violent and injurious in proportion to the progress of the disease^ 
so that when fully formed, emetics, I think, ought never to be exhibited." 

Nauseating doses of tartar emetic, lie also disapproves of. " There is great 
reason," he justly observes, *'to dread the action of this medicine, which too 
often acts as a poison on children when in small doses, and it appears to me 
that the means of relief are very disproportioned to the violence of the disease; 
and, in the majority of cases, very inadequate to remove it. 

"A further, and if possible, more formidable objection, is the length of time 
occupied in giving this treatment a due trial; and where three or four hours are 
allowed to pass away, exhibiting only small doses of nauseating medicines to 
cure croup, the practitioner becomes responsible to a degree which can only 
be estimated by the effects resulting ft'om such a treatment." 

Bhsters, applied upon or in the neighbourhood of the windpipe, in the early 
stages of croup, he considers as decidedly injurious. Here, also, several 
hours must elapse before the operation of the blister commences, much time is 
therefore lost which can never be redeemed; and when the blister does rise, 
the sense of stricture about-the larynx is increased by it, the constitutional dis- 
turbance heightened, the pulse quickened, and the inflammation rendered more 
violent. A heated and close atmosphere is also injurious. 

" From what has already been said, it is evident that two indications are ne- 
cessary to be attended to, in the cure of croup; the first is to subdue the inflam- 
mation of the windpipe, the other to relieve the oppressed circulation. AVithout 
the first object be attained no means will avail; nor will it in every case be safe 
to wait until that can be accomplished, before we relieve the system at large. 
Danger may be imminent from either of these causes, and we have often to de- 
termine whence it is most so, and to regulate our practice accordingly. 

" The causes which produce croup, its symptoms and progress, alike indicate 
the necessity of blood-letting, and this remedy, in comparison with which all 
others sink into insignificance, should be immediately resorted to. Any quan- 
tity of blood may be drawn by leeches, and the local complaint, in almost all 
cases, be subdued by them; for if one crop of leeches do not remove it others 
must follow, until the breathing becomes free, or the child so faint that further 



218 QUARTERLY PERISCOIPE 

depletion would be unsafe. This mode of taking- blood, by emptying the ves- 
sels, which are inflamed will, it is evident, afford relief, with least expense to 
the constitution: but when the complaint has existed many hours, and the ju- 
gular vein becomes alternately distended and collapsed, during each inspira- 
tion; when the angles of the mouth are drawn downwards, every muscle of the 
neck brought into action, and the breathing consists of a series of gaspings, 
there will not be time afforded for leeches, and not a moment must be lost. 
The external jugular vein should be immediately opened with the lancet, 
though this operation is sometimes exceedingly difficult, requiring a quick eye 
and a prompt hand to catch it between each inspiration. The struggles of the 
patient, and the great contraction of the muscles, add to the difficulty; but no 
consideration should deter us from giving instant relief, and no other method of 
taking blood seems to afford the same immediate benefit both to the head and 
breathing. The child may be on the brink of effusion, and every minute lost 
is matter of serious reproach; but this urgency of the case, which if not attend- 
ed to, will speedily be followed by stupor, and that loss of sensibility over the 
whole frame, so favourable to effusion, renders additional precaution neces- 
sary; for if the depletion be carried too far, or the vessels emptied very sudden- 
ly, that event so much to be dreaded will be accelerated. 

"The finger should therefore be kept upon the pulse whilst the blood is 
flowing, and the further flow of blood prevented, if the breathing be properly 
relieved, before faintness is induced. It is safer to trust the further treatment 
of the case to leeches, which are indeed often necessary even when the jugular 
vein has been opened, and the loss of blood carried for the time to the greatest 
extent. This will not be matter of surprise, when we consider how little con- 
nexion there is between the arteries ramified upon the inner surface of the 
wind-pipe, and the external jugular vein. It is safest, therefore, to unload the 
general circulation, where that is requisite, from the system at large; and treat 
the local complaints with leeches where they can be easily obtained; but if 
not, the finger may be placed upon the orifice for a short time, when the 
breathing is relieved; and another and a smaller quantity of blood be taken 
from the same orifice, until faintness deter us from proceeding further. 

"I have generally directed leeches to be put on the lower part of the wind- 
pipe, below the pornum adami, because they bleed quite as well as on the up- 
per part of the tube. The blood is drawn from those vessels, which have most 
recently taken on the diseased action; the inflammation is thereby prevented 
from extending, and the vessels already weakened by disease, are emptied 
more gradually and with less danger of their giving way. 

" In whatever manner the blood be taken, a degree of faintness must be pro- 
duced, and kept up for some time, which renders the continuance of inflamma- 
tion impossible, and the patient watched most narrowly, lest reaction come on, 
and more leeches be necessary. It is now that the ear of the practitioner will 
be most useful to him, and the sound of the cough, the noise which is made by 
the air passing through the inflamed part, andtlie frequency and freedom of the 
inspirations must be closely attended to. He should never leave the bedside of 
the patient until he is satisfied on every one of these points, since he cannot do 
so with safety, or consistently with that duty we all owe, where the life of a fel- 
low creature is at issue. By and bye, he will be rewarded by hearing the cough 
alter its tone, it becomes loosened, there is a little expectoration, and the child 
is safe. 

"It is difficult to convey to the mind of the reader, those shades of difference, 
which minute attention will soon teach him, and it is better perhaps to rest sa- 
tisfied with directing his observation to those points in practice which are really 
important. But I wish to repeat, that a stridule will remain after the respira- 
tion has become free, and though neither this symptom, nor the high sounding 
cough, afford sufficient reason to apply more leeches, yet, the long continuance 
of either of them, is always an object of suspicion, and unless the inspirations be 



Practice of Medicine. 219 

^es, /w//, andsloWy he may rest assured that the inflammatory action is not en- 
tirely removed. 

" I have hitherto considered croup a primary disease, but the majority, and 
the most severe cases are accompanied with, if not produced by, teething-, which 
keeps up the irritation, produces relapse whenever reaction takes place, and is 
accompanied with determination to the head, and a disposition to inflammation 
and effusion there. The state of the g-ums oug-ht always to be attended to, and 
they should be freely lanced,-if there be heat or thickening- over them in any 
part; and this precaution is often necessary, until the child has cut the first of 
its permanent teeth. 

'* During- this time the bowels will have been opened by a dose of calomel and 
jalap, or of castor oil; and the only other medicine I am in the habit of g-iving-, is 
calomel with opium in larg-e and frequent doses. This combination, which before 
the loss of blood, would be hig'hly pernicious, if given only when the head is 
freed from oppression, and the breathing- is quieted, has always appeared pro- 
ductive of the best effects. It produces sleep, appeases the cough, creates 
determination to the skin, and prevents reaction; while the calomel acts here 
as in iritis, by preventing- effusion and producing- absorption. 

" Another advantage arising from the combination of opium is, that it enables 
us to give a larger quantity of calomel, than would be otherwise practicable 
without its passing off by the bowels; and as the glandular system in children is 
seldom affected by it, and ptyalism therefore rarely induced, we need not be 
deterred from giving it largely, and have occasion only to watch its opera- 
tion on the bowels." 

42. White Jgaric a cure for night sweats. — In the Journal der pradischen Heil- 
kunde, for March, 1830, M. Bukdach highly extols the powers of the white 
agaric fboletius laricisj in the night sweats of phthisical patients. A single 
dose of it given in the evening diminishes, he says, the sweats the following 
night, andif repeated several evenings arrests this debilitating symptom. 

The agaric is given in the dose of four grains in the evening. If the patient 
is not irritable, from six to eight grains may be given, and the dose even re- 
peated during the day. It is given in pills with a bitter extract. In cases of 
habitual diarrhoea, the author combines the agaric with kino or alum. 

43. On Traumatic Tetanus. By Dr. Sxm. — " Morbid anatomy is not the only 
source from which we may derive a knowledge of the seat of diseases; physi- 
ology often enables us to point out what organs are in fault, when certain 
functions are disturbed, because we know upon what organs the healthy per- 
formance of those functions depends. Now, the symptoms of traumatic tetanus 
confine themselves so exclusively to the muscles, that it appears to me difficult 
to avoid the theoretical conclusion, that local injuries of the motory organs pro- 
duce the disease, by throwing into a state of morbid irritation the common ori- 
gin of the nerves of the motory system. I say morbid irritation, because we are 
not warranted either by the symptoms of the disease, or dissection, to affirm 
that inflammation is present in every case, or in every stage of tetanus: the vas- 
cular excitement, of which traces are found in the vertebral canal, is more likely 
to have been the effect than the cause of that irritation which is communicated 
to the motory system of nerves, in the same manner as over-exertion of the mind 
causes increased action of the blood-vessels of the brain. I would not, how- 
ever, rest the opinion I entertain, that the profession actually possesses suffi- 
cient grounds upon which to found a rational treatment of tetanus, merely upon 
principles deduced from the doctrines of physiology. Dr. Perry appears to me 
to have undervalued the facts observed by others, as well as by himself, res- 
pecting the morbid anatomy of the disease; for in his own two cases, in the 
valuable collection of cases published by Mr. Adams, in the 10th Number of 
this Journal, and in the two fatal cases contained in my collection in the prece- 
ding Number, the post mortem observations confirm the conclusion, that morbid 



220 QUARTERLY PERISCOPE. 

irritation of the spinal cord had existed during" life. Dr. Perry has added an in- 
teresting appendix to this proposition, by showing a connexion between the 
morbid changes within the vertebral column, and similar changes in the condi- 
tion of the nerves proceeding from the wound: and although, in his first case, 
he states, that the cutaneous nerves were those in which traces of inflammation 
were detected, I must remark, that the superficial peroneal nerve, which he 
particularizes, is principally expended upon the extensor muscles ; and, as it 
lies between the muscular fascia and integuments of the lower and outer part of 
the leg, it must have been implicated in the sloughing and inflammation at the 
seat of the injury. 

What, then, are the means by which we may arrest this morbid action of the 
nervous system of the muscles, or restrain it within safe bounds until it has 
wasted its force ? 1 believe that when one portion of a system of organs, en- 
gaged in performing the same or similar functions, is irritated, the remaining 
portions partake of the irritation by sympathy ; and that when the irritation of 
the former is soothedj the latter partake in the relief. I believe also, that 
when an undue determination of nervous excitement has been directed to one 
system of organs, other systems, performing dissimilar functions, sustain a dimi- 
nution of nervous vigour ; and that the excitement of the former may be allayed 
by irritating the latter. 1 fear we have few direct means of allaying irritation 
in the whole or any part of the muscular system, which are not liable to the ob- 
jection of producing a still greater degree of torpidity in the secretory organs. 
Perhaps the warm bath, as a general remedy, and mild applications to the 
wound, or, if a slough exists, a fermenting poultice, to counteract, by its car- 
bonic acid, the tendency which dead matter has to fall into putrid decorriposi- 
tion, comprise the most useful sedatives: opiates ought not to be employed to 
such an extent as to suspend the action of the other remedies. But in our 
choice of counter-irritants we have a much wider scope, and in severe cases we 
ought to take advantage of the full range. The skin, the mucous membrane 
lining the alimentary canal and urinary passages, and the salivary and biliary 
systems, furnish instruments which may be employed advantageously for the 
purpose of withdrawing from the muscular system a portion of nervous irrita- 
tion. There are, however, certain states of the constitution, in which this 
transfer of irritation is more easily effected than in others. It is effected with 
less certainty when the system is in full vigour, than when reduced. In in- 
flammation of the serous membranes, for instance, in plethoric subjects, if we 
apply a powerful blister to the skin before the force of the circulation has been 
broken by copious blood-letting, we are more apt to aggravate the inflamma- 
tion than to relieve it ; but the same remedy has most happy results, when ap- 
plied after adequate depletion has deprived the constitution of the means of 
supporting two extensive foci of irritation at the same time. Unless, therefore, 
a tetanic patient is already in a proper state for counter-irritation, blood-letting 
ought to precede the use of local stimulants, and it ought to be repeated at 
short intervals until a decided reduction of vascular action has been obtained. 
Blisters and tartar-emetic ointment applied along the course of the spine exten- 
sively and unmercifully, (if I may use the expression,) so as to ensure a severe 
and long-continued irritation, stimulating embrocations, antimonials, and the 
frequent use of the warm bath; purgatives of such a nature as stimulate more 
the mucous than the muscular coat of the alimentary canal, in which view cro- 
ton oil is less eligible than oil of turpentine or neutral salts ; calomel, to excite 
the biliary and salivary secretions ; irritation of the urinary passages by setons or 
bougies, or by cantharides applied to the denuded surface of the cutis, or by 
the internal use of oil of turpentine; — these constitute the means of counter-ir- 
ritation, which have hitherto been employed with greatest success, and which, 
I trust, if employed consistently, energetically, and in combination with each 
other, will, ere long, deprive this frightful disease of more than half its terrors. 
— Glasgow Medical Journaly May^ 1831. 



Practice of Medicine, 221 

44. Treatment of Gout. — We copy from a recent No. of the Londoji Medical 
Gazette^ the following* analysis of a paper read to the Colleg'e of Physicians, by 
its learned president, Sir HEisriiT Hai-fokp. Few if any living" physician has 
had more experience in the treatment of gout than Sir Henry, and his opinions 
are entitled to the most respectful consideration. 

" Sir Henry remarked that he felt as if some apology were necessary for di- 
recting- the attention of those present to a complaint on which so much had 
been written as gout; but, said he, *I rest assured that you will receive in good 
part the result of my long experience in the treatment of that disease, and that 
if I state to you that there is no malady to which I am called upon to administer 
that I prescribe for with so much confidence in the resources of our art as for 
gout — formerly that opprobrium medicorum, you will give me willingly a few 
moments of your attention.' On the various seats of gout he would not dwell: 
in fact, it was to be met with in almost every part of the human frame. Some 
believed they had seen it in the eye, and he had himself witnessed it in the 
kidneys, in the urethra, in the prostate g-land, and in the tonsils. One of his 
colleagues had suffered from it in these, and he mentioned an eminent physician 
in the country so harassed by it, and so disappointed by finding no relief from 
the usual remedies for quinsey, that at length he plunged a lancet into it, in 
case any deep-rooted collection of matter had taken place. None followed, but 
the gout was dislodged, and in a few minutes made an attack upon the great 
toe. The angina disappeared, but the disease ran its usual course in its new 
situation. 

"Among the various remedies for gout, Sir Henry's dependance rests on col- 
chicum. Under ordinary circumstances of gout in the extremities, he does not 
commence its use immediately, but postpones the antidote till the disease shall 
have become fixed: he then directs the wine of the root, prepared according" 
to the formula of the pharmacopoeia; and from this he expressly declared that 
he had not known 'a single instance of any untoward effect.' Frequently it 
removes the complaint without the manifest increase of any secretion: some- 
times it causes perspiration, and sometimes acts as a diuretic; but so far is it 
from being apt to purge violently, as the eau medicinale was wont to do, that 
it is necessary in most cases to add a little sulphate of magnesia. The follow- 
ing is Sir Henry's prescription: — A saline draught, with camphor mixture; a 
drachm of syrup of poppies; and not exceeding from thirty-five to forty-five 
minims of the vinum colchici at bed-time. In the morning- the draught to be 
repeated, but with a little modification, viz. only twenty-five minims of the col- 
chicum wine and half a drachm of the syrup of poppies, while to this is added 
a drachm of Epsom salt. This method is to be pursued for several successive 
days, and then followed up by a pill, composed of three grains of an acetic ex- 
tract of colchicum*, and one or two grains of Dover's powder, with a like quan- 
tity of compound extract of colocynth, the whole being terminated by a mild 
purgative. 'It had been argued,' said Sir Henry, 'that it had been laid to 
the charge of colchicum that its good effects were but temporary: now, even if 
it were so,' he asked, 'whether three or four attacks, of as many days each, 
were to be compared in the extent of suffering they produced, with the weight 
of a six weeks confinement, spring and autumn, which used to be the case be- 
fore the virtues of colchicum were known?' In addition to which, the evils re- 
sulting from the formation of chalk stones in the joints are now almost entirely 
done away — by the controul exercised by this medicine over the inflaramatory 
stage of the disease. But, besides. Sir H. Halford's experience is against the 
correctness of the opinion that gout returns more frequently under the use of 
the colchicum: on the contrary, when the vinous infusion has been followed up 
by the acetous extract, he holds himself justified in asserting that the attacks 
are removed to as long intervals as they used to be when left entirely 'to pa- 
tience and flannel.' The learned author of the paper did not, however, re- 

* Made by evaporating an infusion of the root in vinegar. 

No. XVII. —Nov. 1831. 20 



222 QUARTERLY PERISCOPE. 

commend the above as a specific treatment to be adopted in all forms and va- 
rieties of gout, but as one of general application, requiring to be modified with 
varying circumstances. Occasionally some light preparation of bark is required 
in worn-out frames, to reinvigorate them after the colchicum: occasionally a 
blue pill is of service in restoring the flow of bile when it has become deficient. 
Of the different preparations of colchicum an infusion of the root in sherry, has 
appeared to Sir Henry to be decidedly the best: that made from the seed is apt 
to excite insupportable nausea, and when this has once happened, it is in vain 
that you urge a patient to try it again: he prefers the acute agony of the disease 
to the distressing misery of the remedy. 

*' The learned President proceeded to state that colchicum was not a new me- 
dicine, having been used in the sixth century, under the name of hermodac- 
tyle. Being desirous to ascertain whether this was identical with our colchi- 
cum, he had procured some from the market at Constantinople, specimens of 
which were laid on the table: they appeared to be the same as the common 
meadow saffron, and Sir Henry is about to make trial' of them in gout, in the 
same manner as colchicum. 

*'In preventing the recurrence of the gouty attacks, by far the best remedy 
has appeared to be a few grains of rhubarb, with double its quantity of magnesia, 
every day; or some light bitter infusion, with a little tincture of rhubarb, and 
fifteen grains of the carbonate of potash, if the digestive powers were consider- 
ably impaired. Depletion, either by bleeding or strong purging, are to be 
avoided. But far more depends on the patient's management of himself than 
on any medicines, in keeping the malady at bay. He must live moderately, 
and dine earlier than the present fashion enjoins. Gentle, but regular exercise, 
and a mind free from anxiety, and not exhausted by deep study, are also among 
the precautionary measures; and in addition to these, the patient must be chaste. 
Pliny alludes to this, and uses a remarkable word in expressing it — sanditas. 

"In concluding his valuable and interesting remarks, the learned President 
stated that he had repeatedly seen the waters of Aix-la-Chapelle of much use 
in restoring the weakness of the knees and ankles, brought on by repeated at- 
tacks of other disease.'' 

45. Treatment of Chronic Dysentery by Sulphate of Copper. — It maybe re- 
collected that some years since Dr. Elliotson in a paper in the Medico-Chi- 
rurgical Transactions, recommended the sulphate of copper in the treatment 
of chronic dysentery. The following observations on this subject extracted from 
a clinical lecture given by him at St. Thomas's Hospital in March last will be 
read with interest. 

" There was likewise presented a case oi chronic dysentery ^ which exemplified 
the good effects of sulphate of copper united with opium. This man, like most 
of the patients that we take in here with chronic dysentery, I might say, perhaps, 
all, had been in a hot climate. He had several stools a day, and when he came 
in they were bloody. I began the sulphate of copper in doses of half a grain, 
three times a day, with half a grain of opium. These were gradually increased; 
but while I was employing them, there was no reason whatever for not having 
recourse to any antiphlogistic measures that might appear necessary. He com- 
plained of tenderness in the situation of the transverse arch of the colon; and, 
on that account, leeches were applied there from time to time. I think it im- 
possible to say, as I have already mentioned, in chronic dysentery and chronic 
diarrhoea, whether there is ulceration or not; if, however, there be ulceration, 
that is no reason why a patient should not get well. Intestines are continually 
opened where cicatrices are seen, and sometimes very considerable ones too. 
You will find this mentioned by Dr. Latham, in his work on the Disease of the 
Penitentiary; you will find it mentioned by Andral. You will find that Mr. 
Howship mentions a case of cicatrization to a very great extent. I have fre- 
quently seen intestines in a state of ulceration at some parts, and of cicatrization 
at others, showing that ulcers had healed; therefore, whether there is chronic 



Practice of Medicine. 223 

inflammation merely in these cases, or whether there is ulceration in addition, 
there is no reason whatever for not persevering v/ith our measures: the one case 
may be cured like the other. Chronic inflammation in the intestines will de- 
stroy life equally with ulceration. I have seen people sink under violent purg- 
ings, which have continued for some months, where there was not the slight- 
est ulceration; and, again, I have seen persons who have lived for many months 
with their intestines ulcerated to a great extent. I never saw a greater mass 
of ulceration than in the intestines I showed you last Tuesday, and that man 
had unquestionably been in that state a great many months. The condition of 
the faeces is exceedingly various; sometimes they are bloody, sometimes they 
are not bloody at all. The man, to whose case I have just alluded, never had 
a speck of blood in his faeces; whereas, on the other hand, I have sometimes 
seen in' mere inflammation a great quantity of blood. Then, with respect to 
pus, there never was the appearance of pus in that man's secretion: on the 
other hand, in diarrhoea, you will frequently observe pus, although there is no 
ulceration. In that man's large intestines, the whole mass of faeces was of the 
healthiest description. 

" The present case was useful as showing a fact which is seen continually, res- 
pecting doses of sulphate of copper; namely, that the difference of half a grain 
may make all the difference in the benefit. This man took at last two grains, 
three times a day, with a certain benefit: but, not mending so fast as could be 
wished, the dose was increased to half a grain more; the result of which was, 
that he immediately began to improve rapidly. I believe 1 have mentioned be- 
fore that it should be given in a solid form, and not on an empty stomach; and 
that it is best combined with opium, at least in the first instance. I have fre- 
quently given it with two or three grains of opium, and at last have gradually 
diminished the opium till I left this off altogether. As, however, besides being 
an astringent, it is acrid, it is best to obviate the effect of the acrimony by opium. 
Of course, where it is given with opium, you cannot tell what are the effects of 
the sulphate of copper and what of the opium, because the opium itself has a 
strong tendency to check the diarrhoea. It is only fi'om the comparison of a 
number of cases treated with opium and sulphate of copper, with cases where 
opium only was employed, and from cases where the opium has been greatly 
diminished and omitted, while the sulphate of copper was increased and con- 
tinued, that the fact can be ascertained; and by comparing cases where opium 
was first given alone, and then the sulphate of copper added. It is only by 
these observations that its use can be proved. Of its good effects alone, I have 
no doubt; but knowing the advantage of opium, I consider it my duty to give 
a patient all the benefit that medicine will allow, and therefore 1 unite them to- 
gether, provided the opium do not disagree. 

" There is a case in the same ward at this moment, of chronic dysentery, which 
was very bad, but is now doing exceedingly well, and which also illustrates the 
benefi.t arising from the additioji of half a grain only of the sulphate of copper. 
It has occurred in a young man who, I believe, has been at St. Helena. His 
stools continued bloody; when he came in, he had a great many in the day, and 
had been ill a year and a half; he had ten stools a day, sometimes twelve, some- 
times fifteen. There was tenderness of the abdomen, and, therefore, to give 
astringents without attention to the inflammatory state, would have been wrong. 
Astringents for the diarrhoea were indicated, but still there was so much ten- 
derness that I thought it right to apply leeches to the abdomen, and he had 
twenty applied from the 2d till the 15th, and then 1 began to give him half a 
grain of opium, and half a grain of sulphate of copper, which was gradually in- 
creased till I came to two grains each; under which he continued improving, 
but not so rapidly as I desired. On the addition, however, of half a grain, he 
instantly began to mend very considerably. The last report is, that he had only 
one motion in the course of the twenty -four hours, and that of an healthy ap- 
pearance. His stools before were liquid, and more or less bloody, but now they 
are generally healthy, and rarely show any blood." — Lond. Med. Gaz. June, 1831. 



224 QUARTERLY PERISCOPE, 

46. Treatment of Neuralgia by Moxa. — Mr. Cooper, in a short commumcation 
in the North of England Medical and Surgical Journal, for November, 1830, 
strongly extols the utility of moxa in that form of neuralg-ia arising- from idio- 
pathic inflammation of the nerves, and he relates four cases of neuralgia of the 
sacro-ischiatic nerve successfully treated by this mean. The chronic form of 
this disease usually bids defiance to almost every plan of treatment. Cupping, 
leeches, blisters, turpentine, tartar emetic, warm baths, carbonate of iron, 8cc. 
afford in some instances none, and in others only a transient mitigation from 
torture. In these protracted and severe cases, Mr. Cooper says, " the moxa 
operates a surprising change ? immediately on its application, it entirely subdues 
the pain of the nerve, which in some cases never returns, when the metastasis 
is complete; in others the relief becomes permanent by establishing and per- 
petuating a discharge after the separation of the eschar. 

" Artificial moxa may be formed by immersing lint in a strong solution of 
the nitrate of potash, and after moulding it into a cone and allowing it to dry, it 
will be fit for use. The application is made by placing the base of the cone 
over the affected part, and retaining it in that position till the whole is inci- 
nerated. 

"Case I. — John Robinson, aged thirty-two, by trade a wool comber, applied 
to me in the spring, 1827, for neuralgia of the sacro-ischiatic nerve, under 
which he had laboured above six months, he was quite emaciated, from inten- 
sity of pain, loss of sleep and appetite. The remedies that were tried gave no 
relief till the moxa was apphed, which immediately relieved the pain, and he 
was soon restored to his wonted health and vigour — he has had no relapse. 

" Case II. — September 9th, 1827. — J. Hinchliffe, aged fifty, has had severe 
pain along the whole course of the sacro-ischiatic nerve some months, which 
has greatly impaired his general health, no plan of treatment was of any avail 
till the moxa was applied behind the trochanter, when the relief to the parts 
contiguous was immediate; it required a repetition however before it became 
permanent in this part. The pain continued in the leg notwithstanding the 
application of moxa twice to the hip, this was also entirely removed by em- 
ploying the same agent over the nerve. 

*' Case III. — Elizabeth Thomas, aged forty-three, has had severe pain in the 
sacro-ischiatic since December, 1828; in February, 1830, I applied a moxa be- 
hind the trochanter, which gave immediate ease. The pain still continued in 
the leg, for which a moxa was applied below the knee and was followed with 
the same favourable result. 

" Case IV. — May, 1827.— John Dobson, forty-five years of age, complains of 
pain along the parieties of the chest, which he has felt for several years, and 
which has progressed in spite of all remedies. On examination of the spine, 
there was considerable tenderness of the superior dorsal vertebrae, to this part 
a moxa was apphed with complete success. 

"Cases in confirmation of the efficacy of moxa in neuralgia might be multi- 
plied, but those briefly detailed will suffice to recomm.end it, as deserving of a 
more extensive trial. So uniform has been the success of its application in my 
hands, that it approaches almost as near to a specific, in that form of the disease 
under consideration, as bark is a specific in intermittent fever." 

47. Inhalation of Iodine and Chlorine in Consumption. — We hope in our next 
number to be able to present a summary of the state of our knowledge in rela- 
tion to the effects of iodine and chlorine, in the treatment of pulmonary con- 
sumption; in the mean time the following remarks by the distinguished physician 
of St. Thomas's Hospital, Dr. Elliotson, cannot fail to prove interesting. We 
extract them from a clinical lecture delivered in May last, and a report of which 
we find in the Medical Gazette. 

I have now used, says Dr. Elliotson, the inhalation of iodine in several cases, 
but I cannot say that in one it has yet effected a cure. I have used it in three 
cases, where there was decided excavation of the lungs, and in all three death 



Fractice of Medicine. 225 

has taken place, I should think, much about the time it would otherwise have 
done. These were cases of excavation of the lungs; but whether it would cure 
the disease before excavation has taken place, I cannot, of course, pretend to 
say. I confess I have very great doubts on the subject; and when any person 
tells me that he has ascertained the existence of tubercles in the lungs, and 
found them disappear under the use of iodine or any other medicine, I must be 
well satisfied that that person is a very excellent auscultator, before I can give 
credit to his assertion. I do not think that many people are able to say in gene- 
ral with certainty that tubercles exist in a soHd state, without excavation, and 
that, after a time, these tubercles disappear. I should very much doubt any ob- 
servations of my own on such a matter, notwithstanding I have carefully attend- 
ed to auscultation now for several years; because you cannot satisfactorily as- 
certain the existence of tubercles unless they are very numerous and aggrega- 
ted so as to render one spot of the lungs solid. I have frequently found tuber- 
cles in the lungs after death, where no sign of them whatever was given during 
life. Where, however, they are aggregated, so as to form a mass, there, of 
course, on striking externally, you v/ill find a dead sound, and there will be less 
respiration there than natural, or none at all. But persons ought to be exqui- 
sitely nice auscultators to be able to declare the existence of tubercles with cer- 
tainty, unless the deposition is considerable. We know that in chronic bron- 
chitis, large tubes may be blocked up for a time, so that no respiratory murmur 
can be heard at the spot, and that afterwards these tubes will become open, 
and respiration be heard. I have seen respiration of a whole lung thus abso- 
lutely suspended for a whole fortnight, without any bad symptoms, and then the 
respiratory murmur spontaneously return. When we reflect on this, and the 
extreme difficulty of detecting tubercles, if not thus aggregated, before excava- 
tion has taken place, we ought not to place easy faith in the accounts which are 
given of tubercles having existed in the lungs and been removed. I do not 
presume to assert that such things have not taken place, but I confess I would 
rather witness them myself than believe such observations on the statements of 
others, unless, indeed, they were the conviction of several persons, known to 
be excellent auscultators; not of one or two individuals. I should doubt my 
own observations alone; I would not assert that tubercles had existed, and been 
removed in a single case, unless several friends, on whom I could depend, con- 
firmed my observations on the particular cases, excepting, of course, instances 
of tubercular masses,- and that iodine will remove them 1 much doubt. I would 
not place any reliance upon the observations of any one who declared he could 
ascertain all by the naked ear that others could by the stethoscope; because this 
instrument affords infinitely greater nicet}^ of observation. If the plug is re- 
moved, the sound of both the heart and respiration are greatly magnified; there 
are some places of the chest to which the ear cannot be apphed, as, for instance, 
in the axilla; and the contact of the side of the head with the chest is so much 
greater than of the instrument, that adventitious rustling sound frequently ob^ 
scuresthe observation: lastly, the stethoscope can be apphed to each individual 
point of the chest successively, with extreme nicety and expedition. Of course, 
the naked ear will give great information. But the nicety of the stethoscope 
is altogether far greater. 

I have, however, used iodine in other cases than these three, but what has 
been the result I do not know. Several cases I have not seen again, and others 
are still in progress; but I cannot say that in any of them there has been such 
an improvement as to make me entertain very sanguine hopes of ultimate suc- 
cess. At the same time it would be very wrong to discourage trials. Such at- 
tempts are in the highest degree laudable, and I have no great respect for those 
persons who think that the profession can never be improved, and are content 
with allowing their patients to die under the old-established jogtrot routine of 
means — well established as unsuccessful. We ought not to go on affording 
mere palliation when there is the slightest probability of doing real good, or of 
doing, in the slightest degree, more good than before, bv any new means. I 

20* 



226 QUARTERLY PERISCOPE. 

think it shows a very narrow mind to set one's face against attempts at improve- 
ment. I therefore give credit to all gentlemen who suggest any thing new, and 
still more to those who make exertions to carry such things into effect; but cer- 
tainly I have not found even such temporary benefit under iodine as would give 
me very sanguine hopes. When there has been no evidence of any thing more 
than membranous affection, good has accrued; and, in excavation, certainly 
some alleviation. But I have used chlorine with certainly very considerable al- 
leviation. I am attending a lady at this moment, who could not bear the in- 
halation of iodine in the quantity of a drop of the saturated tincture to three- 
quarters of a pint of water; it produced irritation, and yet she is able to inhale, 
in the same quantity of water, twenty drops of the saturated solution of chlorine, 
and the effect has been such, that her cough is nearly gone, and her expecto- 
ration reduced in a very great degree. I cannot believe that she will get well; 
but the amelioration has been such as I never saw before under the use of nar- 
cotics, or any other means whatever. There is a patient in this hospital labour- 
ing under phthisis and other complaints, and very bad he is, who could not bear 
the iodine. He used the smallest quantity that can be em^aloyed, but it imme- 
diately produced uneasiness, whereas he bears chlorine very well. In him the 
expectoration and the cough have been so reduced, that he will hardly allow 
there is any thing the matter with him. He says I have given him a new in- 
side. The expectoration still exists to a certain extent, but the mitigation has 
been such as I never saw before in phthisis, from any means whatever. Thave 
seen several other cases, both in private and public, where there has been a 
great mitigation under the use of chlorine; but whether it possesses curative 
powers, I cannot, of course, at present say. The iodine 1 know very frequently 
irritates, and it is necessary to add the tincture of conium, or of opium, or prus- 
sic acid, or hyoscyamus, to the solution, in order to prevent its injurious effects, 
but I have not found this necessary with chlorine; and when narcotics have been 
inhaled with iodine, they may often have deserved the whole credit, for I know 
that alone they are extremely useful. 

I beg to observe that these are very crude observations, as I have only been 
using these remedies for two montiis. As, however, I shall not give anymore 
clinical lectures till next season after the present month, it is right that 1 should 
communicate these things to you, because it will be for your advantage to 
know that chlorine, at any rate, will produce such an amelioration as I have 
now mentioned, and that iodine really deserves a fair trial. It is a striking fact 
that persons who cannot bear iodine in any quantity whatever, can bear a full 
portion of chlorine: it is not in one case or two merely that I have observed this 
circumstance, 

1 think, as medical men, vi^e have all been much to blame for neglecting the in- 
halation of various substances, though proposed and practiced thirty or forty 
years ago; because we make applications to the surface of the body when it is 
variously diseased, and to the alimentary canal, and by inhalation we can make 
application to the air-passages themselves, when they are diseased. Nothing 
is easier than to make people inhale different substances by means of warm 
water. Inhalation is a more difficult thing if you employ gases; it cannot be 
done unless you have a large receptacle, with the substances of the exact 
strength that can be borne; but by causing the patient to inhale through impreg- 
nated water, so that the air is impregnated by the substance you employ, you 
can in that way employ any quantity you think proper of various substances. 
You have simply to take a common bottle with a broad mouth, and put a bung 
in it, with two apertures, through which you introduce two glass tubes. One 
of the tubes should pass to the bottom of the fluid, to let down the air from the 
atmosphere, and the air then rises up the fluid to the surface, and ascends the 
other tube, which merely passes through the cork, not descending so low as 
the surface of the fluid, and 'm breathed/row at the opposite extremity by the 
patient. It is the simplest th?ng in the world, and can be employed without 
any expense. 



Practice of Medicine, 227 

48. Powdered Alum, a cure for the Tooth-Ache. — Dr. Kuhn asserts that alum, 
finely powdered, not only relieves the tooth-ache, but that it also arrests the 
progress of caries in the tooth. One or two grains are to be inserted into the 
cavity of the tooth, and this is to be repeated when the pain returns. In a short 
time, the pain will cease to recur, and the chemical action which constitutes 
the caries will cease. — Gazette Med. de Paris, June 5, 1831. 

49. Antidote to Chlorine, and to Sulphuretted Hydrogen Gas. — It results from 
the experiments of M. Hiinefeld, 1st. That when inconvenience is experi- 
enced by the inspiration of too great a quantity of chlorine gas, the best reme- 
dy is to inhale sulphuretted hydrogen gas, which speedily dissipates the serious 
symptoms. 2d. That in case of suffocation or asphyxia produced by sulphuret- 
ted hydrogen gas, the inhalation of the chlorine, in its turn, is the best remedy. — 
bulletin des Sc. Med. January, 1831, from the Archiv. fiir Medoz. Erfahrung, 
Sep. Oct. 1829. 

50. Employment of Calamine to Prevent the Pits of Confluent Small-pox. — 
Mr. George, in a communication in the London Medical Gazette, for April 
last, states that the pits caused by confluent small-pox may be prevented by 
covering the surface of the sores with prepared calamine. In a man, twenty- 
four years of age, who, about the tenth day of the disease, was much exhaust- 
ed by the disease, and in whom the cuticle, from adhering to the bed-clothes, 
was abraded to the extent of six or seven inches on each hip, and to the same 
extent in each ham and on the back, Mr. G. covered the exposed surfaces with 
prepared calamine. In four days the cuticle was every where restored, and the 
patient recovered more rapidly than usual. There was afterwards not a single 
pit to be observed where the cuticle had been so extensively removed, and 
even the immediate surrounding pustules which were unavoidably covered with 
the powder, had not destroyed the cutis. 

51. On Opium in Inflammatory Diseases. — Dr. Bow, in a paper in the London 
Medical and Physical Journal, for July last, strongly recommends the external 
application of Opium in inflammatory diseases. He em.ploys it in the follow- 
ing form. R. Opii. gj. ; Linim. Camph. c. ^j. Digere per dies aliquot et effunde 
linimentum. Many cases of catarrh, he says, are cured by one or two appli- 
cations of this liniment, as if by charm. We give one of his cases, that of a child 
nine months of age, afl^ected with bronchitis. The breathing was difficult, the 
inspirations being short and frequent, accompanied wdth a wheezing noise; the 
face very pale, the lips having a purple tinge; skin exceedingly hot; hoarseness 
of the voice when the child cried; pulse rapid. The child had been ill for 
some days, but the mother, thinking that nothing ailed it except a common 
cold, did not become alarmed until this morning. Nothing had been prescribed 
before I saw it. Two grains of calomel were given, and the breast and back 
rubbed with rather more than a drachm of opiate liniment. 

"The calomel was rejected from the stomach almost as soon as taken. After 
the application of the hniment, the child fell into a sound sleep: at two o'clock 
he awoke, and sucked greedily; and at our visit, a little after two, we found 
him in a profuse perspiration, the voice perfectly free from hoarseness, and 
the breathing comparatively easy. At four o'clock, the breathing had again 
become difficult, but, in degree, nothing equal to what it was in the morning: 
the calomel and liniment were repeated. At six o'clock, the child seemed 
calm and contented; the eyes were sprightly, and some colour had returned to 
the cheeks. A portion of liniment was left with the mother, with orders to ap- 
ply it, should the breathing again become hurried. 

"15th February. — About three o'clock this morning the liniment was applied, 
as the mother thought the state of the .breathing required it. At our visit at 
ten A. M., we found that the bowels had been twice moved; the effect of the 
calomel. The child seemed quite well, and therefore nothing was prescribed. 



228 QUARTERLY PERISCOPE. 

At seven p. m. the child continued well. At the request of the mother, ?. por- 
tion of the liniment was left, to be applied if required. 
16th. The liniment was not applied. Cured." 

52. LeucorrhcBa, — Dr. Bazzoni, in a memoir in the Annali Universali di Med. 
for February last, extols the powers of the secale cornutum in the cure of leu- 
corrhoea. He relates eig-ht cases of the disease relieved by that remedy. 

53. Dropsy cured by Kahinga. — Two cases of dropsy successfully treated by 
the root of kahinca are recorded in the Transactions Medicales for March last, 
by Dr. FjiAjfcois. 

54. Cure for the Tooth-ache. — The learned editor of our esteemed cotempo- 
rary, the London Medical and SurgicalJournalj Dr. Ryan-, recommends the ni- 
tric acid as affording immediate relief in the tooth-ache, when arising from ca- 
ries. He says that he has used it in numerous cases, and invariably with success. 
In some instances the disease does not return for days or weeks, and in others 
not for months. The best mode of employing" it, according* to Dr. R. " is by 
means of lint wrapped round a probe, and moistened with the acid, which is 
then to be slowly applied to the cavity of the tooth; care being- taken not to 
touch the other teeth, the gums, or the cheeks. On withdrawing the probe, 
and inquiring how the patient feels, the usual reply is, *the pain is entirely 
gone.' Tlie mouth is next to be washed with tepid water. The acid should 
be gradually applied to the whole cavity of the tooth, or otherwise a second ap- 
plication will be required before complete relief will be obtained. 

*'This remedy may be used when the gum and cheek are inflamed, so as to 
preclude the possibility of extraction. In cases where the diseased fang re- 
mains, and when the caries faces the adjacent tooth, it obviates the necessity 
of extraction in all cases of hollow teeth, which all practitioners declare to be 
desirable, if possible; and it enables the dentist to perform the operation of 
* stopping or filling teeth,' much sooner than he can otherwise accomplish. In 
a word, it will alleviate a vast deal of human suffering, and supersede a most 
painful operation. It is not a panacea for all the diseases of the teeth and gums, 
though a certain and efficacious remedy for the common cause of tooth-ache. 
It will be a valuable remedy for children, delicate persons, and pregnant wo- 
men. It does not accelerate the decay of the tooth to which it is applied." 



OPHTHALMOLOGY. 

55. On the Utility of Strychnia in certain forms of Amaurosis. By Mr. Mid- 
DLEMOKE, Assistant- Surgeon to the Birmingham Eye Infirmary. — It is readily 
admitted that the term amaurosis comprises a variety of pathological condi- 
tions, not only most diversified in their seat, but various in their state; for in- 
stance, an accumulation of fluid in the infundibulum, producing pressure upon 
the optic nerve; or an alteration of the ossific aperture through which the optic 
nerve passes; an atonic state of the retina, unattended with any organic altera- 
tion; or an increased fulness of its vessels from general plethora, have all been 
designated by the term amaurosis, whenever they have led to much diminution 
of the power of vision; yet nothing can be more different, either as regards the 
seat of the mischief, or the state of the parts affected, than these several mor- 
bid conditions. It is not, however, from an intention to demonstrate the neces- 
sity of adopting a more precise and definite term, for the designation of the 
disease in question, that I have alluded to, what appears to be a great defect 
in the name generally applied to these various conditions of morbid action or 
altered structure, but to point out the necessity of selecting that particular state 
of the system, or the retina, or other part of the nervous apparatus of the eye. 



Ophthalmology. 229 

leading to partial or total bindness, for the employment of a remedy which, on 
two former occasions, I ventured to recommend to the notice of the profession. 
It will be readily conceded, that on this circumstance depends the probable 
success or otherwise of the local application of strychnia in amaurosis; and, as 
I am well aware, that its use is attended with annoyance to the patient, and 
trouble to the surg"eon, and that on this account it is not likely to be had re- 
course to, unless under an impression of its great value; and as the first trial, if 
unattended with advantag-e, will in some instances lead to its discontinuance, I 
shall trespass for a short time upon your pag-es, in order to impress upon the 
serious attention of your readers, the description of amaurotic symptoms which. 
have been present in those subjects, in whom 1 have most advantag-eously had 
recourse to its assistance. 

During- the last sis months I have received from several medical friends, a 
request to take under my care persons suffering- from amaurosis, for the ex- 
press purpose of subjecting them to a trial of the local application of strychnia, 
but in nearly every case they have been very unsuitable subjects; and, in some 
instances, it would have been highly improper to have attempted its use. The 
last patient I saw was one of this description; he was an attorney's clerk, who 
had been accustomed to write for many hours by a strong gas-light; and he re- 
marked, (which, by the bye, is a very general observation,) that he was com- 
pelled to increase the strength of the light until the flame was eventually of a 
very vivid description; the strength of light with which he could see extremely 
well, when he first commenced the burning of gas, afforded him, after a time, 
little more than an indistinct perception of surrounding objects, and he was 
consequently compelled to increase the power of the flame, as has been men- 
tioned; in this way he continued sometimes writing three or four, at others, six 
or seven hours together, by the assistance of this immoderately augmented 
light; by this means an attack of subacute retinitis was induced, an attack 
neither so rapid in its progress, nor so obviously disorganizing in its effects 
as the acute retinitis, nor so tardy in its course as the chronic form of this dis- 
■ease. I did not see this patient until his vision was nearly destroyed, when an 
examination of the eye, and an investigation of the history of the case, assured 
me that it was quite nonsuited to the advantageous employment of strychnia. 
Had the remedy been used in this case, it is quite obvious that the patient would 
have suffered the inconvenience of its application, without any chance of de- 
riving the slightest benefit; and it is by no means improbable that it might have 
been discarded from the good opinion of the gentlemen who had only been in- 
duced to try its powers in consequence of the recommendation of others; 
nothing, however, would have been more unfair than to have concluded from 
such a description of experience, even presuming the strychnia had been tried,, 
that it had no influence upon the disease designated by that indefinite term, 
amaurosis. In nearly every instance in v/hich I have employed the strychnia, 
locally, for the purpose of restoring lost, or improved impaired vision, other 
modes of treatment had been previously adopted, and the patients had been 
under the care of those, who, from my knowledge of their skill and acquire- 
ments, would treat them in the most judicious manner according to the general 
rules of practice in similar cases, so that I have had the great satisfaction of 
proving most unequivocally the decided value of the remedy in question. 

If a person be suffering from loss or diminution of the power of vision from 
an atonic state of the retina, or other part of the nervous apparatus of the eye, 
br of the system generally, the local use of strychnia, (applied in the following 
manner,) will be, in my opinion, the most likely means of removing the defect, 
more especiall}', if it be of recent occurrence. But it will, in many instances, 
be found necessary to institute a most rigid examination, before deciding upon 
the necessity or propriety of the treatment: for instance, the history of the pa- 
tient must be closely investigated, and the eye subjected to the most attentive 
examination, and if the result of this inquiry and examination lead to the opi= 
niou that the defect does depend on the atonic condition of one, or all the parts 



230 QUARTERLY PERISCOPE. 

to which I have just alluded, he may, with safety, be subjected to the very te- 
dious and somewhat painful plan of treatment it remains for me to explain; but 
it will be readily admitted, that if this examination be not conducted in the 
most careful manner, it will be impossible to discriminate, with any approach 
to certainty, the particular conditions of the retina, and other parts of the 
nervous apparatus of the eye, productive of amaurosis, which admit of allevia- 
tion or removal; nor can the trial of strychnia, without such a preliminary in- 
vestigation, be viewed, as otherwise than a rash and criminal procedure; a pro- 
cedure which is more likely to destroy the power of vision for ever, than to 
yield any prospect of relief. Having- pointed out that condition of the retina, 
or other parts of the nervous apparatus of the eye, or of the system, (which 
I have termed atonic,) capable of being relieved by the local application of 
strychnia, it may be thought right to complete the treatment, it may be fre- 
quently necessary to combine with this local remedy; but as my object is mere- 
ly to recommend the employment of the more important remedy; and as the 
various tonics and stimulants, which it may often be adviseable to use at the 
same time can be readily adapted to the circumstances of individual cases; and as 
they form but a very secondary and subordinate part of the treatment, I shall 
not extend my observations, nor trespass upon your pages to attempt the sup- 
ply of this trivial deficiency. 

The following case not only illustrates the mode of using the strychnia, but 
explains the condition of retina producing amaurosis, which has appeared to me 
likely to be benefited by its use, unless, indeed, it be admitted, that a suspen- 
sion of its action for a long period, induces some alteration of structure, not in- 
dicated by constitutional symptoms, nor evidenced by local changes, by which 
it is permanently unfitted to receive and obey the stimulus of light. A few years 
ago, I attended a Miss P. of this town, who had, many years since, been ope- 
rated upon for cataract, by the late Mr. Saunders; she was about nine years old 
at the time of the operation, which was very welVperformed, if we may judge 
from the appearance of the eyes, which do not present any traces of inflamma- 
tory mischief, and are only to be distinguished from perfectly healthy organs by 
the large size of the pupil, a rotatory motion of the eyeball, and a small rem- 
nant of capsule at the side of the pupil, this girl is highly intelligent, and in a 
moderately good state of health, and, with the exception of the defects just 
mentioned, her eyes are perfectly natural and healthy in appearance, and yet 
she has never been able to distinguish the form, colour, or magnitude of sur- 
rounding objects, having merely a perception of light, and a capacity to distin- 
guish its degrees, when varied from an extremely feeble to a very brilliant light; 
a power which she possessed, though to a less extent, prior to the performance 
of an operation- Considering the defect of vision to have arisen in consequence 
of permitting the retina to remain for so many years unimpressed by its natural 
stimulus, and that by exciting its sensibility, it might still be rendered obedi- 
ent to the stimulus of light, I employed the strychnia in the following manner: 
— having placed a blister over each eyebrow, and afterwards cut away the rais- 
ed cuticle, so as to expose an extensive surface, which would be likely to pre- 
vent the frequent necessity of re-blistering the part, I sprinkled the strychnia 
equally upon the whole of the surface, commencing with the sixth of a grain 
upon each, and gradually augmenting the quantity until I was enabled to use a 
grain upon each side, at which time she had occasionally a much increased per- 
ception of light, with frequent scintillations; but, unfortimately, the remedy be- 
gan to affect the head, producing so much uneasiness and nervous disturbance 
that I did not judge it prudent to persevere in its use any longer, much less to 
increase the quantity, to that extent, which, in my opinion, was indispensable 
to success. In the course of the treatment, I was pleased to hear this patient 
complain of the sensation of scintillation, us, on former occasions, that symptom 
had been frequently followed by the most satisfactory result; and although in 
this instance I was unable to persevere as I could have wished, in consequence 
of the extreme head-ache and other symptoms, yet it is still hoped, that on 



Ophthalmology, 231 

some future occasion, she may be enabled to bear the requisite treatment, 
without a recurrence of these untoward symptoms. 

There is one other circumstance which was remarked in this case, and which 
appears to me worthy of recording-; when the bhstered surface had healed in 
its circumference, I was compelled to place nearly the whole of the strychnia 
upon a very small space, indeed, a great part of it was dusted upon, and imme- 
diately around the situation of the supra-orbitary nerve; and it was observed 
that the remedy acted with greater advantage, than when placed upon a larger 
extent of surface. It immediately occurred to me that the nervous connexion 
subsisting between this branch and the nervous supply of the iris, afforded a 
satisfactory explanation of the circumstance. Acting upon this impression, I 
repeated this mode of application upon a patient soon afterwards, and instead 
of applying a long narrow blister over the whole eye-brow, and partly upon 
the temple, as on former occasions, I directed the lower border of tlie blister- 
ing jDlaster to be placed, as nearly as possible in, and just above the situation 
of the supra-orbitary notch, desiring that it might not extend beyond the outer 
edge of the eye-brow, and, in this case also, the advantage of limiting the ap- 
plication of the remedy was equally evident. As, however, the quantity it may 
be necessary to use, in order to produce the desired effect, will in some patients 
be considerable, and, as we cannot calculate upon the absorption of a thick 
layer of powder, with the requisite degree of rapidity, it will often be adviseable 
to scatter it more extensively; bearing in mind, of course, that only as much of 
the strychnia must be placed in the situation we have considered to be that in 
which it acts most efficiently, as can be absorbed within the time allotted for a 
second application. 

If, in the case of Miss P. the use of strychnia had been commenced soon after 
the failure of the operation of solution had occurred, there would have been 
every prospect of the recovery of a much greater degree of vision than she at 
present enjoys; but, as the retina had remained in an unexcited state for so 
many years, it was not probable that any treatment would restore its power, 
and it was only after an explanation to this effect; after having explained the 
very little chance of success the application of the strychnia afforded, in con- 
sequence of the long duration of blindness, that I consented to adopt the treat- 
ment she was desirous of undergoing. 

The following brief directions will include all that I have hitherto found ne- 
cessary to insure the full action of this remedy: place a narrow blister over 
each eye-brow, which must not extend beyond a line drawn upwards from the 
external canthus: when it has risen sufficiently, cut away all the cuticle and 
apply, for half an hour, a piece of linen to absorb the serum, which is apt to 
be discharged in large quantities for a short time after the removal of a blister, 
thy dust the remedy chiefly in the situation of the supra-orbitary nerve, but 
nor so thickly as to prevent the entire absorption of the whole layer of the 
powder, at the time of the second dressing, which should be, as nearly as pos- 
sible, twenty-four hours afterwards; twenty-four hours between each dressing 
is a proper and necessary interval; cover the blistered surface with a piece of 
linen very thinly spread with ung. cetacei, for, if much greasy matter be mixed 
with the powder, it is less easily and quickly absorbed; but, unless a little be 
applied, the linen adheres to the wound and occasions great pain in its remo- 
val. Increase the dose of strychnia very gradually until the state of vision is 
improved, or symptoms indicative of the injurious agency of the remedy occur. 
If there be much local pain excited by the application of the strychnia, dilute 
it with flour, or mix it with opium; and if that do not succeed, suspend its em- 
ployment until the stomach and bowels be improved by a plan of treatment in- 
stituted expressly for their benefit, and then resume its use; if severe pain 
in the head, convulsive muscular twitchings, great general nervous excitement, 
or other symptoms, denoting the injurious agency of the strychnia upon the 
constitution supervene, and the condition of vision be not improved, it must be 
discontinued altogether; as it would appear probable that in such case it was 



232 QUARTERJ.Y PERISCOPE. 

not likely to exert a favourable inflaence upon the disease, at the same i'me^ 
that from some peculiarity of constitution, it was calculated to do important 
general mischief. 

The case of Miss P. is one, amongst others, which have fallen under my no- 
tice, strong"ly illustrating the propriety of the recommendation of the late Mr. 
Saunders, with regard to the early performance of an operation for the removal 
of congenital cataract. As it is impossible to conceive a greater argument in 
support of the opinions of that amiable man and excellent surgeon, upon this 
subject, than the remarks of Dr. Farre on the success of his (Mr. Saunder's) 
operations, performed upon children at various ages, 1 shall beg leave to make 
the following brief extract from them. The sensibility of the retina '• in many 
of the cases cured at the ages of four years and under, could not be suppressed 
in children who had enjoyed vision from birth; but at eight years, and even earlier, 
the sense was evidently less active; at twelve it was still more dull; and from 
the age of fifteen and upwards, it was generally very imperfect, and sometimes 
the mere perception of light remained." 

On account of this disposition of the retina to remain in a permanent condi- 
tion of inaction, when unaccustomed for a long time to the influence of its na- 
tural stimulus, it has been recommended on high authority, to remove a cataract 
from one eye, when fully formed, when its fellow is perfectly healthy; appa- 
rently forgetting that the retina of an eye so circumstanced, is by no means in 
the same unexcited state as that nervous expansion in the eyes of a patient af- 
fected with congenital cataract. For, if one eye only be affected with cataract, (not 
congenital,) the other eye remaining perfectly healthy, the action of light upon 
the retina of the sound organ, will produce a sympathetic impression to a cer- 
tain extent, upon the other, and thus preserve its susceptibility, though in a 
diminished degree; whereas, in the case of congenital cataract affecting both 
eyes, the retina has never been fully and perfectly impressed with the stimulus 
of light, and its susceptibility gradually diminished on the one hand, whilst its 
stimulus declines on the other; the declension of stimulus arising from the in- 
creasing density and opacity of the cataract, and the diminution of susceptibility 
being dependant on the inactive state of the retina, increased by the gradually 
diminishing quantity of light transmitted through the humours of the eye, from 
the cause to which we have just adverted. 

It has been said that, if a mature cataract be allowed to remain in one eye, 
it disposes that organ to become amaurotic, and has a tendency to excite a si- 
milar disease in its fellow; and whilst it hmits the sphere of vision, it weakens 
the opposite organ by the undivided labour it obliges it to sustain. As I have 
never had the slightest reason to believe that an opaque condition of one lens, 
possesses in itself any capability of exciting a similar state in the lens of the op- 
posite eye, and as my attention has been particularly directed to the investiga- 
tion and elucidation of this circumstance, I must refuse my assent to this doc- 
trine, until future observation has increased our knowledge upon this point. 

With regard to the other objections, I will merely observe, that whenever 
one eye only has been affected with cataract, which has not been congenital, nor 
produced by accident, the vision of that eye has been generally restored by an 
operation, however long the cataract may have existed; or, rather, the retina 
has, after such operation, indicated its capacity to be properly excited by its 
natural stimulus. Of course I am presuming that the operation has been judi- 
ciously adopted and properly performed, and that no effects injurious or de- 
structive to vision, have been produced by the operation. If congenital cata- 
racts had been permitted to exist for the same number of years, as in the cases 
now referred to (though not detailed,) from my notes, and which have furnished 
me with the data for my present opinions, the degree of success consequent 
on the performance of an operation for their removal, would have been much 
less considerable, and, in many instances, judging from the result of operations 
undertaken for the cure of congenital cataracts, upon patients at the age of ten 
and upwards, no vision whatever would have been restored. 



Ophthalmology, 233 

From these remarks, and from opinions formed after the maturest delibera- 
tion, I would deduce the following- conclusions; and 1st, that althoug-h the re- 
tina in the case of congenital cataract affecting- both eyes, is likely to remain in 
a permanently atonic state, if the opaque lens be not removed at an early period 
of life, yet the same condition of retina is not likely to be produced by the ex- 
istence of cataract in one eye, for an equaL number of years. 2nd, that experi- 
ence does not warrant a belief, that the existence of an opaque lens in one eye, 
has a tendency to excite a similar disease in the opposite org-an. 3rd, that 
so long" as the sig-ht of one eye remains perfect, the field of vision is sufficiently 
extensive for every useful purpose; and lastly, that in many persons who have 
lost the power of vision with one eye, the sig-ht of the remaining eye has con- 
tinued with the same, or nearly the same, degree of vigour, as under ordinary 
circumstances. — Midland Medical and Surgical Reporter ^ May and JIugusf, 
1831. 

56. On the efficacy of the Nitrate of Silver Ointment in leucoma, and dense opa- 
city of the cornea. By Mr. Middlemoke. — Sometimes the cornea may be the 
seat of leucoma, which may or may not be combined with synechia anterior; 
and if this leucomatous state of the cornea be very extensive, or unusually dense, 
the power of vision will be very generally limited to an indistinct perception of 
lig-ht, and, in other instances, vision will be totally destroyed. In such cases, 
the iris will be frequently uninjured, and the deep-seated textures unimpaired, 
and the retina quite capable of performing- its proper function, if the opaque 
condition of the cornea did not prevent the transmission of light. It is, there- 
fore, a point of the utmost importance, to remove this opaque state of the cornea 
with as much speed as possible; but, in many of these cases, the oxymuriate 
drops, and the various stimulants usually employed for this purpose, either fail 
to remove it altog-ether, or do so onl)^ partially, after the lapse of a very long- 
period. In tliese instances, 1 have witnessed the most surprising results, from 
the application of the nitrate of silver ointment, used daily, or every other day, 
according to the effect it produces. Many persons, who had relinquished all 
hope of recovering any useful degree of vision, and who, according to the or- 
dinary mode of treatment, would scarcely, under the most favourable circum- 
stances, have discovered any increase of vision, after one or two years attend- 
ance, have been partially restored to sight in as many months; and in the space 
offiveorsix months, the leucoma lias entirely disappeared, except at that 
point where the ulceration of the cornea, producing the leucoma, had extended 
through the whole, cr nearly tlie whole, of its layers. 

If this leucomatous condition of the cornea, or a state of simple opacity of 
the cornea, (always presuming that the corneal opacity be very extensive, and 
of considerable density,) be connected with an enlargement of vessels^ which 
enlargement may be confined to its conjunctival covering, or may form the os- 
tensible vascular organization of the substance constituting the opacity or leu- 
coma, and may be therefore more deeply situated; the same mode of treatment 
is equally applicable, and will be equally successful. When either of these 
states of the cornea occurs as the result of purulent ophthalmia, the chances of 
success will be still greater, on account of the comparatively short period which 
has elapsed since the new substance, constituting the opacity, has been depo- 
sited and organized, and the greater activity of absorption at that early period 
of life. — Midland Med. and Surg. Reporter, August, 1831. 

57. Pannus. — In our department of Materia Medica, we have given the formula 
for the preparation of nitrate of silver ointment; that ointment Mr. Middlemore 
recommends in various affections of the eyes, and among others, he states that 
it is calculated to render the most important service in that thickened, opaque, 
and vascular state of the conjunctival lining of the eye, usually termed pannus. 
This condition of the mucous covering of the cornea, is frequently combined 

No. XVll.— Nov. 1831. 21 



234 QUARTERLY PERISCOPE. 

with, and produced by, a vascular and granular, or, (what is more infrequent,) 
a cutaneous state of the palpebral conjunctiva; but, whether this condition of 
the palpebral conjunctiva be present or otherwise, whether the mucous cover- 
ing of the cornea be merely thickened and rendered opaque, or, in addition to 
this thickened and opaque state be also vascular, Mr. M. says that the use of 
the nitrate of silver ointment is equally called for, and promises the most speedy 
and material relief. Of course it would be desirable to cure any defect requir- 
ing operation for its removal, which appeared to be maintaining and increasing 
this morbid condition of the cornea, before having recourse to the ointment; 
for instance, there may be an incurvation of the tarsal cartilage, an irregularity 
in the growth of one or more of the eye-lashes, or an inversion of the whole of 
the eye-lashes, from their unnatural position at the inner border of the tarsal 
margin, which having produced the alteration in the translucency of the cornea, 
to which I am now adverting, it would be adviseable, indeed, indispensably re- 
quisite, to remove, as a preliminary measure to the adoption of any curative 
plan of treatment whatever. But the mere removal of this defective condition 
of the tarsal cartilage, the integuments of the eye-lids, or the direction of the 
eye-lashes, will not be sufficient to restore the translucency of the cornea; and 
it is with a view of curing the effects any one of these conditions may have pro- 
duced, and which the mere removal of the cause which produced them, will 
not accomphsh, that the present plan of treatment is proposed. — Ibid. 

58. Chloruret of Lime in Purulent Ophthalmia. — We have already noticed. 
Vol. I. p. 459, the chloride of lime having been successfully employed 
by Dr. Varlez of Brussels, and Mr. Guthrie of London, in the treatment of 
purulent ophthalmia. In a late number of the Journ. Comp. des Sc. Med. Dr. 
Herzberg relates four cases, in which he employed this remedy with advan- 
tage. 

We have ourselves employed it in a few cases, but without the striking be- 
nefits we were led to expect from the representations of others. It will require 
further experience to determine its real value. 



SURGERY. 

59. Excision of Scirrhous Rectum. — Mr. Lisfra^tc has excised the lower ex-» 
tremity of the rectum in nine cases, of which six were successful, for the re* 
moval of what is termed by French surgeons, cancer. The peritoneum descends 
along the front of the rectum to six inches from its extremity in women, to four 
inches from the same in man. By means of an ovoid incision in the skin around 
the anus, the rectum can readily be drawn out behind, and any kind of instru- 
ment may be applied to it; there exists a second sphincter above the first. M. 
Lisfranc has removed as much as three inches and a half of the rectum, and he 
recommends the operation whenever the forefinger can reach beyond the upper 
margin of the disease, and when the cellular texture, external to the gut is 
sound. The operator must bear in mind that the antero-posterior diameter of 
the perinaeum is generally one inch, the distance of the anus from the coccyx 
eighteen lines, and that between the anus and the base of the same bone two 
inches, that considerable portions of the rectum may be removed laterally and 
posteriorly without wounding the vagina in woman, or the urethra in man; and 
finally, that haemorrhage may always be arrested by pressure or by ligatures. 
In the performance of the operation the patient is to be placed as in the lateral 
operation for lithotomy — two semilunar incisions are to be made around the 
anus — and the rectum to be insulated in its inferior extremity, drawn down by 
the forefinger introduced into its cavity, and cut off by means of scissors. 
After the cure, the faeces are sometimes voided in the usual manner, sometimes 
a bourrelet is formed internally, and takes the place of the sphincter, sometimes 



Surgery. 235 

there is incontinence of liquid faeces, and sometimes the patient is obliged to 
stuff the rectum with lint. — Med. Chirurg. Beview, July^ 1831. 

60. Extirpation of Cancer of the Rectum. — M. Maukust also has performed this 
operation successfully on a patient, at the Hospital of Versailles. The patient 
was a man thirty-one years of age, of delicate constitution, who presented him- 
self to M. Maurin in the beginning" of September, 1828, complaining that he 
could not procure a stool, except by the aid of enemata; and that he felt great 
weight and acute pains in the rectum. On examination by the finger, a hard 
and irregular tumour was discovered, about two inches from the anus, ulcerated 
in the centre, and discharging a sanious ichor, of a most intolerable fetor. The 
mobility of the tumour, notwithstanding its distance from the orifice of the gut, 
induced the surgeon to entertain the idea of extirpation. Baron Dupuytren 
was consulted on the 17th of September, and made the following note: "There 
exists about two inches from the orifice of the rectum a carcinomatous tumour, 
occupying one side of the gut, to the extent of about two inches. There is 
no chance of a cure, except by an operation — and this operation must be both 
difficult and dangerous. If the patient shall make up his mind to the risk of 
the operation, I am ready to attempt it." Sept. 2\st. Encouraged by this 
opinion of so celebrated a surgeon, M. Maurin himself determined to operate. 
For this purpose he made an incision through the posterior and left part of the 
sphincter, by means of a probe-pointed bistoury, when the tumour was seized 
by a kind of tenaculum, and drawn downwards gradually and gently, till it ap- 
peared in view, when it was carefully removed by means of scissors. When 
taken out, it was found to be of an oval form, a httle flattened, and two inches 
in length, with an ulceration on one side. It was of a very compact tissue. The 
operation was very painful, and considerable haemorrhage attended, but was 
soon arrested by stuffing the rectum. In the course of five hours after the 
operation the patient experienced acute pains in the epigastrium, with dysury, 
sharp fever, and intense thirst. Two bleedings relieved these symptoms, and 
he slept some in the course of the night. In the morning the pulse was reduced 
from 140 to 100, and the patient was again bled. When the dressings were re- 
moved, there issued a considerable quantity of pus with blood. In the course 
of the succeeding days the stale of the patient was improved — the purulent dis- 
charge lessened — the lancinating pains ceased, and, by the 15th of November, 
the discharge was almost nothing. Consistent and spontaneous stools were 
passed. On the 1st of December the wound in the sphincter was found to be 
cicatrized. On the 8th of the same month, the patient was discharged from the 
hospital cured. He experienced no difficulty or pain in passing his motions. 
—Ibidy Revue Medicale, Feb. 1831. 

61. Excision of Ulcer of the Rectum. — This operation has been performed by 
Mr. Mayo, at the Middlesex Hospital. The patient was a female, thirty-eight 
years of age, who, for two years previously had experienced pain in the rectum, 
when the bowels were evacuated. This increased in severity, and was attended 
by unpleasant sensations about the loins, &c. and some sanguineous discharge. 
In December, 1830, she entered the Middlesex, labouring under severe pains 
in the rectum, with the occasional issue of pus and blood. 

On examination of the rectum, it was found to be indurated and ulcerated to 
the extent of two inches; but the finger could be passed beyond the diseased 
part into a healthy gut. Various remedies were tried, but in vain. Mr. Mayo 
then determined on an operation. 

**The operation was performed on the 25th of February, in the following 
manner: — the patient was laid upon her side, with the hips and knees bent. 
The fingers being then introduced into the rectum, the knife was plunged into 
the perinaeum, on one side of the bowel, and, an incision of some depth being 
thus made laterally, the dissection was continued forwards from thence, so as 
to separate the vagina from the rectum. The dissection was then continued 



236 QUARTERLY PERISCOPE. 

entirely round the rectum, including- half an inch of integument, with the 
sphincter muscle. By this means, a length of two inches and a half of the ex- 
tremity of the rectum was separated from the adjacent parts: it was then cut 
off with scissors from the sound rectum above. The operation was performed 
slowly, and the vessels, about nine in number, were tied as they were divided. 
The patient lost about twelve or fourteen ounces of blood." 

In about two hours after the operation, and when the smarting" of the wound 
had subsided, she observed that she found herself entirely relieved from the 
pain and distress to which she had been subject for so many months. The ap- 
pearance of the wound is singular. The extremity of the bowel is not more 
than half an inch from the cut edge of the skin, and the intervening granula- 
tions are healthy and rapidly cicatrizing. The bowels act regularly once a 
day; and the patient is aware of the presence of the faeces in the rectum. In 
about five minutes after this sensation is perceived, the bowels act much jn the 
usual manner, though it is evident that there can be nothing at present equiva- 
lent to a sphincter muscle. A hope is entertained that when the wound is cica- 
trized and contracted, the patient will have some power of retaining- solid faeces. 
— Lond. Med. and Phys. Journal, Mpril, 1831. 

It is stated in a subsequent No. of the Journal, (that for June,) from which 
we take the report of this case, that the general health of the v/oman was im- 
proved, and the sufferings she experienced from the disease entirely removed 
by the operation. She can even perfectly retain her faeces. As might be ex- 
pected, however, when she is under the influence of purgative medicine, the 
contents of the bowels are discharged rather quickly; but it seems far from im- 
possible that, in time the firm cicatrix at the wound, assisted by the action of 
the muscular fibres of the bowel itself, will form a sufficient substitute, on all 
occasions, for the sphincter muscle, which has been removed. 

62. Amputation of the Thigh at the Hip- Joint. — In the Glasgow Medical Journal 
for August last, a case of this, terminating successfully, is related by Dr. Charles 
Brtce. The subject of the case was a Greek soldier, twenty-three years of 
age, who was wounded by a six pound ball, at the battle of Athens, on the 6th 
of May, 1827. The ball struck the posterior and lateral part of the left thigh, 
immediately below the trochanter. The integuments and muscles of the hip 
and thigh were very extensively torn and removed. The trochanter, neck and 
four inches of femur were broken into minute pieces, but the femoral yessels 
were untouched, and the mass of flesh on the inside, formed by the adductors, 
vastus internus, and gracilis, was uninjured. The person complained much of 
pain, from the distortion of limb, but suffered little from weakness or depres- 
sion. The bleeding from the wound was inconsiderable. Some wine being- 
given him, and the leg disposed as favourably as circumstances would permit, 
he was conveyed on board an hospital ship. Upon examining the limb, in re- 
ference to an operation, the gentlemen assisting coincided in opinion, that am- 
putation was authorized under the most favourable circumstances, and that, in 
our actual state of disturbance and movements, any delay of operation was 
quite inadmissible. The plan of proceeding was readily determined on, and 
executed without difficulty, in the following manner: — Firm pressure being- 
made by the cross-piece of the screw of a tourniquet and a pad on the external 
iHac, immediately above Poupart's ligament, a convex incision was made across 
the highest part of the thigh and hip, passing- from the inside of the sulcus of 
the blood-vessels, to an inch and a half behind tlie trochanter, including in this 
convexity and extent the torn superior circumference of the wound, and ex- 
posing the capsular ligament of the joint. 

The femoral artery was now secured above the branching off of the circum- 
flex and profunda. The capsule and round ligament were next divided, the 
acetabulum exposed, and the head of bone drawn out. The amputating knife 
was again taken, and, observing the particular shape of the upper incision, a 
corresponding flap was formed, by a double stroke of the knife, from the inner 



Surgery. 237 

and under part of the thigh, in which the fractured portions of the bone, and 
the contused and lacerated soft parts were included. The arteries were now 
secured, and the wound cleared of blood. Notwithstanding- frequent ablutions 
of the wound with cold water, there existed a troublesome oozing" of blood, 
without our being- able to detect its sources, by which, and the fatigue of the 
operation, the patient became exhausted. Wine and assuring language re- 
stored him somewhat. Jt was evidently dangerous to dress the wound imme- 
diately; and leaving, therefore, its surface uncovered, exposed to the air, (a 
method frequently had recourse to in other similar cases,) we proceeded to 
another amputation. By this management the wound became so dry, after a 
few minutes, as to allow the operation to be satisfactorily finished. The flap 
covered very well the face of the wound, and was easily retained in proper 
contact by strips of adhesive plaster. The common dressings were applied, 
and a double-headed roller was carefully adapted to the peculiar form of the 
hip. An anodyne was exhibited, and six hours after the operation he was com- 
posed, and had slept; no pain nor bleeding from the wound. 

The irregular movements of the army and navy, in consequence of the me- 
lancholy event of this battle, forced Dr. B's attendance elsewhere, and pre- 
vented him seeing the patient before the fourth day of the operation, when he 
found him conveyed to Poros, truly well, considering the many privations and 
hardships the poor fellow had undergone during the preceding days. The 
edges of the wound, though irritated, showed no disposition to separate, nor 
was the flap tense or swollen. The general system suffered from febrile feel- 
ings, anxiety, and restlessness, but the disturbance was not greater than the ir- 
regular and neglected state of his bowels, and the irritation in the stump could 
account for. Upon the whole. Dr. B. was agreeably disappointed in his expec- 
tations of his condition; and entertained sanguine hopes of his recovery, more 
especially that some arrangement had been made to ensure professional atten- 
dance on the wounded. During two days Dr. B. was at Poros, the patient re- 
covered from every untoward symptom, and the wound was dressed and looked 
well. When Dr. B. returned to this place, after six weeks, he was delighted 
to see his patient completely cured and healthy. 

63. Lithotrity. — M. Segalas has communicated to the Royal Academy of 
Medicine, the case of a man, forty -five years of age, who, for the relief of dys- 
pepsia, caused by mental and physical fatigue, was restricted to a vegetable 
diet, consisting in great part of sorrel. Two paroxysms of violent nephritic 
colic soon supervened, and frequent hematuria. A urinary calculus was de- 
tected by the lithontriptor, and it was removed at a single operation. Chemical 
examination showed it to consist of oxalate of lime. M. Segalas offers two 
2«emarks in relation to this case: 1st, that the calculus, which could not be de- 
tected in two examinations with the sound, was afterwards detected with the 
lithontriptor; 2d, that lithotrity has here cured a patient in a single sitting, who 
was too nervous to submit to lithotomy. — Archives Generaks, May, 1831. 

64. Lacerated wound of the Perinaeum, with fracture of the hones of the Pelvis — 
Recovery. — The following case related by George C. IlAifKiisr, Esq. in a recent 
number of the London Medical Gazette, affords an interesting example of the 
powers of nature. A farmer of Upper Canada was crossing a narrow dam, 
"when meeting a loaded cart he unfortunately locked his wheel, and in back- 
ing to extricate himself lost his balance and fell out of the cart over the dam; 
the horse continuing to back went over also, with the cart, and was killed on 
the spot. The dam was about 30 feet high, and the cart fell over the man. The 
first sight showed a part of the sphincter ani, the whole perinaeum and scrotum, 
torn away, in the form of a triangle, the apex of which was at the anus, and ly- 
ing over the penis on the abdomen, leaving the testes perfectly denuded, and 
?iispended like two eggs. How, under such circumstances, they escaped en- 
tire destruction, I cannot conceive. On a nearer inspection, I found the subja- 

21* 



238 QUARTERLY PERISCOPE. 

cent soft parts in a dreadful state of laceration, a part of the ramus of the ischium 
gone, and the ischium itself fractured between its tuberosity and the acetabu- 
lum; the left crus of the penis and urethra divided; and, on passing- my fingers 
under the testes, removed several portions of the os pubis, which were appa- 
rently chipped off as if by some sharp instrument, and which, as well as a large 
portion of the ramus, I have preserved. In addition to the above, the right arm 
was so completely shattered, that I was under the necessity of amputating it 
some days after, not with any hope of ultimate recovery, but merely to relieve 
the patient from the pain which the splintered bones occasioned. 

** Looking upon this as a desperate case, I merely replaced the parts in sitUf 
ordered poultices to be constantly applied, and the patient to be kept as quiet 
as possible. In this state he continued, labouring under the greatest excite- 
ment, until the 26th, about the tenth day after the accident, when I perceived 
that the injured soft parts had entirely sloughed off, the stump still continuing a 
good deal swollen. On the 28th, that state of collapse consequent on too great 
*excitement, and which I had looked forward to as the event which was to put 
an end to his sufferings, was strikingly depicted on his cadaverous countenance; 
the stump was flaccid, and the wounds put on a languid appearance. I ordered 
wine to be given freely, and had the unexpected pleasure of seeing him somfe- 
thing better on the 30th, and complaining of the pain occasioned by the pointed 
bones. Removed such parts of the ramus as 1 could get at with the bone- 
nippers, and succeeded in extracting two or three small splinters of the pubes, 
which had caused much irritation. From this time he appeared evidently to 
improve; the stump, as well as the wound, soon began to show a secretion of 
healthy pus. At the end of a month from the amputation the! stump was quite 
healed, and in another fortniglit the injured bones of the pelvis had completely 
exfoliated, and healthy granulations were fast filling up the frightful void which 
had been made in the soft parts; and In the beginning of March (1830,) instead 
of my visiting him as formerly, he came to me as long as the snow lasted, in a 
sledge; his long confinement in the recumbent posture, having afforded ample 
time for the tuberosity of the ischium to reiinite to the body of the bone, so that 
he could very soon sit up without much inconvenience. 

*' The only thing further to be done for him was to endeavour to reestablish the 
natural passage for the urine, instead of allowing it to continue to pass by the pe- 
rinaeum. This I attempted, and though unsuccessful, am still perfectly convinced 
of its practicability. After introducing the catheter, and irritating the edges of the 
wound, adhesive plaster was applied, and I feel confident would, in forty- 
eight hours, have secured a union by the first intention, had it been allowed to 
remain; but, to my great disappointment, I found next day that the catheter 
had been removed by some officious friend, and I could not prevail on him 
again to permit its introduction. I would not be surprised, however, t<j hear 
that nature had ere this done for him what he would not permit to be done by 
art; for when I last saw him, in August, 1830, he informed me that when he 
opposed any obstacle, as the end of his finger, to the passage of the water by 
the perinseum, it readily passed through the urethra. 

" During the whole course of this case, the only prescriptions used were pec- 
toral mixtures, to relieve a very troublesome and irritating cough, and an occa- 
sional aperient; and after the discontinuance of the poultices, the cerat. cala- 
min. with lotions of sulph. zin. and an occasional touch of nit. argent, to 
keep down luxuriant granulations, were the only local applications found neces- 
sary. 

"Of ail the cases which fall into the hands of the practitioner in surgery for 
treatment, there are perhaps none from which he may obtain more credit to 
himself, in great measure at the expense of nature, than in extensive lacerated 
wounds; the alarm which any loss of substance invariably excites amongst the 
ignorant in surgery naturally inclining the patient to bestow all the credit upon 
his attendant, which the surgeon himself is content, in his own mind, to divide 
with nature. 



Surgery. 239 

"I am not aware of there being any case on record, accompanied with so 
many discouraging circumstances as the above, in which the patient has reco- 
vered; and the only object in view in preserving it, (as such cases are fortunate- 
ly of rare occurrence,) is to afford another proof of the ahnost entire depen- 
dence to be placed, under such circumstances, in the vh medicatrix naturas." 

65. Traumatic Tetanus. — The following cases of tetanus reported in the 
Glasgow Medical Journal for TehTnary last, by Robert Perht, M. D. senior 
surgeon to the Glasgow Royal Infirmary are interesting from some of the ap- 
pearances noticed on dissection. 

Case I. Patrick Vallily, xtat. 15. 17th April, 1830. A few hours ago, while 
sitting near the funnel of a steam-boat engine, the boiler exploded, and he was 
lifted into the air. Both legs and posterior part of left thigh are extensively 
vesicated, both arms and shoulders slightly so, occasioned by the hot water 
thrown on him. Pulse quick and feeble, has had no vomiting. Sumat. stat. tinct. 
opii. gtt. xl. 

18th, Occasional vomiting; in other respects easy. Hab. opii. gr. i. vesp. 

19th, Seems confused, but no return of vomiting; complains only of pains of 
abdomen, which is slightly tender oi^ pressure. Tongue white and moist; pulse 
100; bowels open. Cont. opii. gr. i. vesp. Adhibeant. abdomeni, hirud, xii. 

20th, A rigor this morning; half an hour after was bled to 9 oz. Blood first 
cup buffy. Complains of slight pain of abdomen on motion, but there is no ten- 
derness on pressure. Pulse 100; tongue white; thirst; bowels slow. Rep. infus. 
sennsc c. sulph. magnes.; Vesp. rep. venesect. 

21st, Bled to six ounces. Pulse 120; tongue less white; bowels open. Feels 
much easier. 

26th, Since last bleeding ha,s continued much easier. Pulse has fallen in fre- 
quency, and tongue cleaning. 

29tb, Convalescent till 27th, when complained of pain in abdomen; not in- 
creased on pressure; had an opiate, which was repeated last night; to-day was 
found lying on his back, head retracted, and muscles of the head and trunk 
rigid; countenance anxious, and features retracted. Slight difficulty on deglu- 
tition, but can open his mouth pretty freely. Pulse 105; tongue whitish at 
edges, brownish and dry in centre. Sum. st. calom. "^i. et posthor. tres infus. 
sennse donee plen. dejec. alv.; Post. sol. alvihab. enem. c. tinct. opii. ^i.; Spin, 
applic. vesicat. 

oOth, Physic operated well, and in the evening less permanent rigidity of the 
muscles, but the accumulation of phlegm in trachea most annoying. Spasms 
increase in frequency. Complains of pain in the region of the heart. Pulse 
124; tongue brown and dry in centre. Sum. 3tia q. q. h. calom. gr. x. c. opii 
gr. iss. ; Curet. pars vesicat. ungt. sabins. 

May 1st, It was at this date the patient came under my care. Since last re- 
port the spasms of the muscles of the trunk have become more severe and pei'- 
manent; less able to open his mouth, severe pain at epigastrium, no stool for 
the last 24 hours, has continued the calomel. To have powdered opium sprinkled 
on the vesicated portions of legs. 

2d, Thirst urgent. Tongue dry; pulse 110. R. 01. croton. gtt. iii. pulv. 
sacc. gr. vi. M. et divid. in d. iii. Sum 1 3tia q. q.h. Applic. catap. com. vesi- 
cationibus. Omit. p. opii. 

3d, Has had several dark stools from the croton oil; tension, and pain of ab- 
domen, diminished, but spams still continue. Pulse in the morning feeble, but 
become stronger since taking a little wine. 4 P. M. Pulse sunk considerably; 
in consequence of which, 4 oz. of spirit were ordered to be taken in divided 
doses with warm water and sugar. Spasms continued till 5 next morning, when 
he died. The body was immediately placed with the face to the floor. 

Inspection 24 hours after death. The whole spinous processes and calvarium 
were removed, the brain and thecae vertebrarum fully exposed. There was a 
little serous fluid at the base of the brain, betwixt the tunica arachnoidea and 



240 QUARTERLY PERISCOPE. 

pla mater. The brain was considerably more vascular than usual, and on the 
posterior part of both lobes of the cerebellum there existed an ecchymosed ap- 
pearance, which could easily be removed by raising the pia mater. The medulla 
spinalis had a perfectly healthy appearance, but a considerable quantity of partly 
fluid, partly coagulated blood, existed betwixt the theca and the vertebrae. The 
vesicated surfaces occupied the lowerhalf of the leftleg, and the outer andlower 
half of the right leg. Both had a green sloughy aspect, and the cellular sub- 
stances was much inflamed. The veins did not appear more vascular than 
natural, and the arteries appeared healthy. The nerves were also carefully ex- 
amined; the cutaneous of both legs, particularly the communicans tibialis and 
the communicating branches of the peroneal nerve with the tibialis communis, 
were inflamed at the seat of the injury; tracing them upwards above this point 
they were perfectly healthy, except that portion of the peroneal which turns 
over the head of the fibula, there it was again distinctly very vascular, thus leav- 
ing an intermediate portion perfectly free from the appearances of inflammation. 
The vascularity appeared to be confined to the sheath of each nerve; the deep- 
seated branches appeared to be quite natural. No other morbid appearances 
were detected. 

Case 11. William Fleming, jetat. 17. 22d July, 1830. Eight days ago, the ring 
and middle fingers of the right hand were drawn in betwixt two teethed wheels, 
and the integuments much lacerated; the last phalanx of the middle finger was 
completely crushed, and separated from the second, except at its fore parts, 
where a small slip of skin kept it adherent; this was removed shortly after the 
accident, and the fingers dressed at first with adhesive straps, the day before 
admission had poultices applied. Last night began to experience severe pain 
in fingers, which, before yesterday, had been tolerably easy; at the same time, 
was seized with tetanic symptoms, of stiff'ness of the muscles of the neck and 
lower jaw, and pain at epigastrium. 

On admission to-day, at 2 P. M. the symptoms above related, somewhat 
aggravated, but did not prevent him walking up to the hospital; there is at pre- 
sent slight rigidity of the sterno-mastoid muscles, deglutition easy. The second 
and last phalanges of the injured fingers are completely gangrenous, and the in- 
teguments separated from the first, exposing the bone, of a black colour. Has 
severe pain in bruised fingers, very much increased on the slightest pressure; 
pain does not stretch up arm. The bones of the second phalanx of both fingers 
are fractured; the fore and little fingers are uninjured. Bowels are easy. Had 
12 grains of calomel immediately on admission, and 14 leeches applied to the 
nape of the neck, and at 6 P. M. both bruised fingers were removed. The mid- 
dle finger was taken off at its junction with the metacarpal bone, and the two 
last phalanges of the ring finger. Torsion of the arteries was used in place of 
ligatures, to stop the haemorrhage, (a practice I have always adopted in ampu- 
tations of the fingers and toes) during the operation, of which he complained 
much; had distinct opisthotonos. The calomel not having operated, was ordered 
sulph. magnes. ^ii. tart. ant. \ gr., o. h. 

23d, The salts and tartar emetic were continued every hour during the night. 
Bowels have been freely opened; vomited occasionally. Muscles of the back 
and belly have become rigid, and at times distinct opisthotonos occurs; is unable 
to open his jaws so far as to put out his tongue, the attempt to do so generally 
brings on general spasms. Complains much of pain of right breast. Pulse 140, 
full and soft; skin moist; slight head-ache; makes water freely; has some difficulty 
in swallowing. Cont. tart, antimon. gr. \ tantum. o. h. Oraitt. sulph. magnes. 
Hah. acetat. morph. gr. ^ o. h.; Fricet. pect.j c. tinct. opii, et sap., et colli nuch. 
app. vesicaf. 

10 P. M. Spasms less frequent, but more severe; can open mouth better; has 
had no stool since visit at 1 P. M. ; has taken regularly the quantity of morphia 
and tartar emetic prescribed; feels drowsy, and has vomited a little. Pulse 160, 
full, and rather hard; water has been drawn off by catheter. Repet. sulph. 
magnes. et tart, antimon. ut antea. 



Surgery, 241 

, 24th, Died this morning at 7, the spasms continuing both frequent and severe. 

Inspection, 24 hours after death. The body was allowed to lie the usual way 
on the back till the time of inspection. The calvarium and spinous ridges were 
removed, fully exposing the thecavertebrarum, down to the cauda equina; there 
was no effusion on the brain or its membranes, and its substance was natural 
throughout. No effusion existed between the theca and the vertebrae; the theca 
was healthy, and betwixt it and the spinal cord was a preternatural quantity of 
serum. The cord itself was of a pale colour. The nerves on each side of the 
remaining phalanx of the ring finger were very vascular. On tracing upwards 
the ulnar nerve from this point to the elbow, it was of its natural colour, but 
here again it became very vascular for about the extent of 2 inches. In the 
axilla it again presented a similar appearance as at the elbow, the portion of it 
intervening betwixt these two points being healthy. Tracingthe median nerve 
in the same way as the ulnar, it was found perfectly natural, from its digital 
branch, which supplied the radial side of the ring finger, (and which, as stated 
above, was much inflamed,) till about the middle of the arm, when it again 
presented an inflamed appearance for the extent of I5 inch. The portion of it 
intervening betwixt this part and that confined to the axilla, where it again be- 
came vascular, was natural. This vascularity throughout, was not confined to 
the sheaths of the nerves, but occupied their substance; the radial and superfi- 
cial nerves of the arm, along with its veins and arteries, were perfectly natural; 
the lumbar nerves were unaffected; the oesophagus was examined, and found 
healthy; the trachea appeared inflamed, and contained a large quantity of green- 
ish coloured mucus; the other thoracic viscera and digestive organs natural. 

The plan of treatment followed in the above cases may be considered as purely 
empirical, indeed, the treatment of this disease may be said to have been 
hitherto uniformly so, and must continue so while the seat and nature of the 
disease is unknown, as remarked l^y Mr. Cooper, in his excellent Surgical Dic- 
tionary,— " Nothing is a more certain proof of our not being acquainted with 
any very effectual method of treating a disease, than a multiplicity of remedies, 
which are as opposite as possible in their effects." To give even a summary 
of the remedies employed, and the plans of treatment strongly recommended, 
would occupy too large a space, and be of little use, from all of them being 
founded upon conjecture. Although the morbid appearances in the two in- 
spections related correspond very closely, it would perhaps be rash to found 
upon them (until confirmed by other cases) any certain plan of treatment; yet, 
I think I would be warranted in treating- any case of the kind which might occur, 
as a local inflammation of the nerves leading from the seat of the injury, the in- 
terruption of the suppurative process in the wound being one of the first ap- 
pearances. When the tetanic symptoms arise from fracture of any of the fingers 
or toes, or even compound or comminuted fracture of the larger extremities, 
we miglit be warranted in having recourse to amputation; at all events, a strict 
antiphlogistic treatment, with the application ofnumerous leeches in the course 
of the affected nerves, followed by Misters, ought not to be neglected; warm 
poultices, stimulating fomentations, or the turpentine liniment, ought to be api- 
plied to the wound, and these local remedies, accompanied with the free exhibition 
of emetic tartar, either combined with sulph. magnesise dissolved in water, or 
with calomel and opium in small but repeated doses, so as to act both on the 
skin and bowels — the torpid state of the latter in this disease, indicate an iur 
terruption or weakened state of the nervous system, which may arise from the 
increased expenditure or exhaustion of nervous power by the diseased parts. 

66. Wound of the Trachea— Occlusion of the Larynx — Jerial Fistula.— M. Re- 
NAun has recorded in a late number of the Journal Hehdomadaire, a case 
of this description. The subject of it was a man named Leblanc, twenty- 
five years of age, who was compelled to fly his home in consequence of a 
criminal offence, and seclude himself in another part of France. Three years 
afterwards, observing some gens-d*armes approaching him, and suspecting that 



242 QUARTEKLY PERISCOPE. 

they were in ptirsuit of him, he resolved upon suicide. Seizing upon a bis- 
toury, he always carried about him, he plunged it into that part of his throat 
corresponding with the space between the cricoid cartilage and trachea. The 
point of the instrument being directed upwards, it entered the larynx, and made 
its way out again, being directed from one side to the other. A profuse 
haemorrhage ensued; and his answers to the gens-d'armes were not intelUgible. 
They conveyed him to the nearest village, where he was unable to procure 
professional assistance for several hours. It was found necessary to introduce 
fluids into the stomach, for the pui'pose of alimentation, by means of a tube, 
and in twenty days the patient began to have some power of articulation. But 
in proportion as the external wound healed, the difficulty of breathing increas- 
ed; and in six weeks after the accident, the unhappy Leblanc, fearing the offi- 
cers of justice, contrived to make his escape to a distant part of the country, 
where he took refuge with his brotlier. Then the terrible difficulty of breath- 
ing suggested to Leblanc the idea of reopening the original wound, in hopes 
of either putting an end to his life or his sufferings. With this intention he took 
an opportunity of pushing a knife through the cicatrix, and thus giving a free 
vent to the respiration. In this auto-operation, Leblanc made an opening into 
the pharynx, but of small extent. His brother arriving in an hour, was terrified, 
and applied to the magistrate of the place, who procured a physician to examine 
into the state of the patient. He was conducted to the Hotel Dieu of Rheims, 
where an attempt was made to reiinite the wound; but the difficulty of breath- 
ing which ensued, caused them to abandon the attempt. The event was left 
to nature, and in a fortnight the wound of the pharynx was healed. In pro- 
portion as the laryngeal wound healed, however, the dyspnoea increased, as on 
the former occasion; and to prevent suffocation, the patient himself constructed 
a tube of lead, two inciies in length, and more than an inch in circumference, 
which he introduced, with some difficulty, but which gave him complete faci- 
lity of breathing. He was obliged, of course, from time to time, to remove the 
tube, in order to clean it, and give issue to accumulated mucosities. In two 
months, he was completely well, with the exception of the inconvenience of the 
tube. And now the unhappy man was brought before a tribunal of justice, 
and was condemned to death. The severity of the sentence was, however, 
mitigated into perpetual labour. He was sent to work at a public construction 
in Toulon, where he arrived on the 11th of September, 1822. There he work- 
ed till the month of August, 1825, when the leaden tube slipped into the tra- 
chea, and became impacted at the origin of the right bronchus. There it ex- 
cited constant and violent fits of coughing. He was sent to the hospital, and 
the instrument' was extracted by a surgical operation, no details of which are 
given. During the patient's stay in the hospital, M. Renaud ascertained the 
complete occlusion of the larynx, by various experiments; and yet the patient 
was able to articulate many words with very considerable distinctness. Many 
of the most distinguished medical men of Toulon corroborated these facts. 
They all became convinced that the articulation of sounds in Leblanc's case, 
was made in despite of the entire occlusion of the larynx. This man could speak 
so distinctly, as to be heard and understood at some distance. There were cer- 
tain words and letters, however, which he could not pronounce, as, for exam- 
ple, the letters a, c, 1, and especially o. When he attempted to speak, he 
opened his mouth wide, depressed the larynx, and then, by a violent effort, ex- 
pelled what air he could, as if by the act of coughing. Leblanc became the 
subject of repeated attacks of bronchitis, which ended in phthisis, of which 
he died on the 28th of July, 1828. 

The dissection was made in the presence of the Council of Health, and vari- 
ous officers of the hospital. The complete occlusion was satisfactorily proved, 
the obliteration of the passage being where the trachea joins the larynx. The 
problem remains to be solved how Leblanc could speak, under such circum- 
stances. Our readers may remember the case of Mr, Price, of Portsmouth, 
who still breathes through a tube in the trachea. In his case there is a small 



Surgery. 243 

apetture still for air, though not sufficient for respiration. His voice is almost 
extinct.— Mc?. Chir. Rev. July^ 1831. 

67. Case of severe Scald treated by Nitrate of Silver.-^" The following case of 
severe scald, by an anonymous correspondent, demonstrates the utility of the 
nitrate of silver in this kind of affection, while it exemplifies its powers in 
changing and controlling the action of the capillary vessels. 

" A little child, five years old, was pushed backwards by another child, whilst 
naked, into a large pan of scalding water which had been just taken off the fire. 
It was taken out as quick as possible, and yeast was apphed upon the injured 
parts. It was visited one hour after the accident. The whole of the back as 
high as the shoulder-blades, and as low as the middle of the thiglis, was found 
severely scalded, the cuticle removed from some parts, and in other parts raised 
into large vesications. The whole of the belly, the penis, scrotum, and thighs, 
were also in a similar state, but not so severely scalded as the back. An opiate 
was administered, and the yeast was removed with a sponge and warm water? 
it was well that no oily application had been used, as its removal would have 
required more trouble and have given more pain. The loose cuticle was remov- 
ed with that of all the larger vesications, and the small ones were punctured, so 
that a clear surface was obtained, to which the nitrate of silver might be applied, 

** The whole surface was then moistened with pure water, and a long stick 
of the nitrate of silver was applied flat, once over the whole surface, and a little 
on the surrounding healthy skin. A little linen just moistened was then past 
over every part to diffuse the nitrate of silver, so that no spot might be left un- 
touched. The child cried much less than was expected when the nitrate of 
silver was applied on the denuded cutis. The back on which the child would 
have to lie was then covered with neutral ointment spread upon linen, secured 
by a bandage. The thighs and belly were left exposed to the air to form an 
adherent eschar, being defended by a fracture cradle. 

" On visiting the child about eight hours afterwards, it was reported to have 
fallen asleep in a quarter of an hour after the application of the nitrate of silver, 
and to have complained of no pain since. There appeared no constitutional 
disturbance. 

" The very first morning after the accident this little patient was turned on 
his side enjoying some playthings with several playfellows who were by the 
side of his bed. One part on the side of the thigh was much swollen and in- 
flamed. It was discovered that the nitrate of silver had not been applied upon 
it. The whole of the belly and the other parts of the thighs exposed to the air 
looked very well, with scarcely any vesications; the eschars were removed in 
two places where the tapes of the bandage had crossed the belly; these parts 
were now defended by means of a small plaster of neutral ointment spread on 
linen. On some parts the eschars were floating on the serum, these afterwards 
became adherent. The scrotum and penis were much swollen, but gave no 
pain. The nitrate of silver was applied on the part not attended to at the first 
dressing. 

" On the second day the child was going on well; some of the eschars were be- 
coming adherent; the scrotum and penis continued much swollen, but there was 
scarcely any pain, and that on the belly. There was a slight heat of skin, and 
tongue' was a little loaded. A purgative with senna and salts was given. 

" On the third day nearly the whole of the eschars were found to be adhe- 
rent, and the scrotum and penis less swelled. 

"On the fourth day the eschars were quite adherent on the belly, and the 
penis and scrotum were of their natural size. 

" On the fifth day the plasters of neutral ointment were removed from the 
back, which presented an appearance of a recently blistered surface, in a heal- 
ing state, with some loose cuticle partially attached; there was no appearance 
of suppuration. . ^ 



244 QUARTERLY PERISCOPE- 

** In several days more the back was healed, except in two or three small 
parts, which were scalded more deeply than the rest, and were covered Over 
with coagulable lymph, nor the least suppuration having" taken place. The es- 
chars were peeling off the belly, leaving- the subjacent surface quite healed. 

<* On the tenth day this little patient was out of doors, and on the twelfth at 
school, every part being* quite healed. 

**Mr. Hig-ginbottom, in his Essay on the use of the Nitrate of Silver, makes 
the following observations on burns and scalds: 

** * I have found that, by slig-htly passing tlie nitrate of silver once over a burnt 
surface, the pain is increased for a short time, but then totally subsides, vesica- 
tion appearing to be prevented^ the black cuticle peels off in a few days, leav- 
ing the part well. In cases in which the cuticle has been removed, the nitrate 
of silver applied on the surface induces an adherent eschar, and prevents the 
consequent ulceration.* p. 149. 

*' * I have not had an opportunity of using the nitrate of silver in very extensive 
recent burns, but I can have no doubt of the benefit that would accrue from it. 
It should, I think, be applied over the whole surface of the burn or scaid once 
only but as in external inflammation; then the parts most severely burnt should 
be covered with lint, and the whole of the burnt surface with the neutral oint- 
ment spread on linen, a bandage being applied to retain the dressings in their 
places. I should expect that the inflammation would be checked, and the con- 
sequent vesication, ulceration, and sloughing, in a great measure prevented, 
except in those places where the fire had actually destroyed the parts deeply. 
I should not examine the parts again before the fourth or fifth day; and if the 
dressing adhered I would let them remain during another similar period. The 
application of the nitrate of silver should be repeated in the same manner, as 
might appear to be required. I think the burn would then be limited in its ex- 
tent, and would consequently be less dangerous; for the danger is generally in 
proportion to the extent of surface destroyed. The nitrate of silver has cer- 
tainly the property of removing the irritability of the whole surface to which it 
is apphed, and cannot add much to the pain of the burn itself.' p. 150. 

"These anticipations appear to be correct when the nitrate of silver is ap- 
plied to a burnt or scalded surface from which the cuticle is not removed. It 
has the immediate effect of subduing the heat or burning pain, preventing ve- 
sication, and causing it to terminate by resolution. 

** When the skin is denuded of the cuticle and the nitrate of silver is applied, 
this most irritable and inflamed surface is converted into an insensible covering, 
which remains adherent until the inflammation is gone, and the new cuticle is 
formed underneath, at which period it loosens and drops off. 

*' The application of the nitrate of silver is equally efficacious whether the 
burned or scalded surface be afterwards exposed to the air or covered by the 
neutral ointment. In the first case an adherent eschar is formed in two or three 
days; and in the second the effects of the nitrate of silver appear to continue 
for four or five days, producing a constant flow of serum, which continues un- 
til all the inflammation, irritation, and pain, are gone. It is possibly of little 
consequence which plan is adopted, as both are healed about the same period. 
The adherent eschar would be preferable in parts exposed, as the face and 
neck; or the chest, belly, or legs too, if defended by a fracture cradle, and the 
patient in bed. 

** The advantages of the nitrate of silver in the treatment of burns and scalds 
appear to be of the very first importance. We have at once a covering for the 
injured and very irritable surface superior to an}^ other formed and composed 
partly of the very surface itself. The nitrate of silver acts as an anti-injiamma- 
iory agency both immediately and for several days after its application. 

it may be safely applied over the head, chest, or abdomen, and it is not, like 
arsenic, and some other remedies used externally, liable to be absorbed into the 
system." — Edinburgh Medical and SurgicalJournal, Aprily 1831. 



Surgery. 245 

68. Treatment of Syphilis without Mercury. — Dr. Traill, of Liverpool, in an 
interesting- account of the general hospital at Hamburg in the North of Eng- 
land Medical and Surgical Journal^ for June last, furnishes us with the following 
observations on the treatment of syphilis in Hamburg. " In so great a seaport, 
in so luxurious a city, it may readily be supposed that syphilis is not a rare dis- 
ease; and from the constant influx of persons from every quarter of the globe, 
one might be led to conclude that the disorder, in its most disgusting forms, 
might be found in the hospital of Hamburg. In this, however, we should be 
mistaken. I had the satisfaction of accompanying Dr. Jacobson, of Copenhagen; 
Dr. Eckstrbin, of Stockholm; and other eminent physicians, to the hospital, 
where Dr. Fricke had the kindness to submit to examination a great number 
of syphilitic cases, and to detail the history of each, as he pointed out the va- 
rious stages of the complaint. 

•* The public prostitutes, on the first symptoms of this disease, are compelled 
to enter this hospital; and we had full leisure and opportunity to examine the 
various forms of the disorder to which they are liable. 

" The mode of inspection is very minute, and is regularly practised, in all 
cases, by the medical officers, with a patience and manliness to which there is 
among us no parallel. Every change of symptoms perceived by Dr. Fricke is 
announced, and immediately entered in the case book by one of the assistant 
surgeons. Among thirty or forty females of that class, then minutely inspected, 
I did not discover a single instance of deep chancre with retorted edges. The 
chief symptoms were slight ulcerations, often little else than excoriations, con- 
dylomata or warty excrescences; and in incipient cases, specks of purulent 
matter filling the orifices of the mucous follicles or glands on the parts within 
the labix, and which were often so minute as to require a magnifier to render 
them apparent. In this insidious form of the disease, as Dr. Fricke remarked, 
the several symptoms of syphilis may be communicated by a female, without 
her being at all aware that she is diseased. Such instances he stated as having 
often fallen under his observation. He pointed out many examples of this af^ 
fection of the mucous follicles within the labise,- and, with a fine silver wire, de- 
monstrated the existence of minute collections of matter in them, and, by slight 
inflammatory action, for a time closing their orifices. Among all the prostitutes 
here collected, I did not perceive a single case of ill-conditioned chancre, or of 
corroding ulceration; and even simple buboes were not very numerous.* Of 
secondary syphilis, with the exception of a few cases of cutaneous eruptions, 
and ulcerated throats, chiefly among seamen, there were fewer traces than I 
ever saw among so many patients labouring under this disease. Blenorrhosaim- 
pura and leucorrhcea are very frequent, especially among the prostitutes. 

*' Every form of syphilis is treated in the Hamburg hospital without meh- 
cuRx iif ANT porm: and I have the authority of Dr. Fricke, and ot all the other 
medical gentlemen of the establishment, for the impui tant fact, that they never 
find the disease to require its use, and that this mode of treatment is not more 
liable than the mercurial one to be followed by what are considered as second- 
ary symptoms. 

" I did not find a single instance of any person disfigured by the disease; ex- 
cept one female, whose nose had fallen in before she was received in the house; 
and she had previously undergone a severe course of mercury in Berlin. Since 
her admission here, she has been treated on the anti-mercurial plan; and when 
I saw her, she appeared to be convalescent. This method of cure consists in 
frequent ablutions with tepid water, a very rigid low diet, almost amounting to 
starving, brisk purgatives and rest. Zinc and saturnine lotions are occasionally 
employed, but the circumstances above enumerated are the great means of 
cure. Even sarsaparilla is little used, and mercurials never. The success of this 

» The ill-conditioned chancre with ragged retorted edges might indeed be found among sailors re- 
ceived into the hospital; but the remarkable exemption of the public prostitutes from the sererer forms 
of the disease is not a little worthy of attention. 

No. XVIL— Nov. 1831. 22 



246 QUARTERLY PERISCOPE. 

practice is established by the experience acquired in the present hospital and 
its predecessor, at least as far back as fifteen years ago. 

" Dr. Eckstrora, physician to the king- of Sweden, informed me that the same 
treatment had been still longer pursued at Stockholm with equal success; and 
that the practice was adopted at Hamburg from the example of the Swedish 
hospital; which however borrowed it from the Royal Hospital at Copenhagen, 
where it had been established by the experience of a Danish physician, a pupil 
of our celebrated John Hunter. 

" After the demonstrations were concluded, Dr. Fricke asked my opinion on 
the nature and treatment of the diseases he had shown. On remarking that few 
of the cases among the prostitutes appeared to have what we considered de- 
cided marks of virulent syphilis; and that many of them would be considered 
little more than excoriations, or the consequences of gonorrhoea; he justly re- 
marked, * Whatever opinion might be entertained on that subject, it was no 
less remarkable, if we refuse to give the name of syphilis to these diseases, 
that, among the class of persons most exposed to venereal infection, the public 
prostitutes, in one of the largest seaports of Europe, proverbially dissipated, 
true syphilis is unknown: for we had seen every variety of the disease which is 
usually met with in Hamburg.' 

" He further added that the anti-mercurial mode of treatment had never, to his 
knowledge, been followed by diseased bones, unless where much mercury had 
been previously used; and the remark was confirmed by Dr. Eckstrom." 

69. Case of Spontaneous Varicose Aneurism. — By James Stme, Esq. F. R. C. 
S. L. andE. — Varicose aneurism, or a sac containing blood, and communicating 
with the trunks of both an artery and vein, is a rare occurrence; and the only 
instances which have hitherto been recorded either of it, or the analogous con- 
dition of aneurismal varix, where the blood passes at once from the trunk of an 
artery into that of a vein, originated from wounds. The femoral, popliteal, and 
subclavian vessels, and more frequently those at the bend of the arm, have 
been thus affected, in consequence of having their contiguous coats divided by 
some sharp-pointed weapon; but no instance has hitherto been observed of the 
opening taking place spontaneously, and I therefore think it right to relate the 
following case of varicose aneurism, which aflTected the aorta and vena cava, 
and occurred without any external violence. 

Robert Scott, aged twenty-two, in the beginning of October, 1830, began to 
complain of pain in his back and limbs, throbbing in the epigastric region, and 
an incessant whizzing noise, which seemed to proceed from the same part. His 
sufferings became so severe in three or four weeks, that he found it necessary 
to confine himself to bed, and then came under the care of my friend Dr. Ro- 
bertson, who soon afterwards requested me to see him. He complained greatly 
of pain in his back, and coldness of his feet; but what seemed to occasion both 
him and his friends most concern, was the constant noise that has been already 
mentioned. On examining the abdomen while he lay on his back, I readily 
felt the pulsation of a large tumour; but it was not so strong and incompressi- 
ble as that of an ordinary aneurism, and in the erect posture might have readily 
escaped observation. 

The treatment consisted in the use of all those means which tend to moderate 
the force of the circulation, but proved quite unavailing. The patient's suffer- 
ings became progressively aggravated, and a new symptom made its appear- 
ance, viz. cEdema of the inferior extremities and generative organ*. The swell- 
ing of these parts attained a degree that I never saw equalled, and occasioned 
an extraordinary contrast between them and his superior extremities, which 
were thin and emaciated. In the latter end of January the patient died rather 
suddenly, immediately after complaining of a pain at his heart. 

After death, the oedema, which had previously been confined to the parts 
below the pubis, diffused itself over the whole of the body, so that when the 
dissection was commenced by the usual longitudinal incision of the integuments 



Surgery. 247 

of the trunk, they were found to be distended fully three inches, and a copious 
stream of seroias fluid continued to issue from them, during nearly the whole of 
the subsequent examination. 

In order to expose the disease completely, I removed the thoracic and ab- 
dominal viscera, and then traced the aorta from the commencement downwards. 
Having" found an aneurismal tumour seated at the bifurcation of the artery, 
which adhered intimately to the vena cava and vertebrae, I dissected out the 
iliac vessels, cut them across some inches beyond their division, and then sawed 
away the bodies of the lumbar vertebrae, together with the promontory of the 
sacrum. 

On examining more particularly the preparation thus detached, we observed 
that the tumour was of a flattened oval figure about the size of a large orange; 
that it adhered to, and had caused absorption to some depth of the bodies of 
the three lowest lumbar vertebrae, and that it was intimately connected with the 
vena cava, which appeared much flattened, distended, and thickened. It was 
now suggested that there might be a communication between the aneurism and 
vein, and on making a small opening into the sac, so as to evacuate its con- 
tents, we found this actually to be the case. Immediately above the bifurcation 
of the vena cava there was a round aperture somewhat larger than a sixpence, 
which afforded a free entrance into it from the aneurism. — Ed. Med. and Surg. 
Journal, July, 1831. 

70. Lithotrity. — We have already announced, Vol. VII. p. 246, that the ge- 
neral administration of hospitals had given to M. Civiale the charge of a ward 
in the Hospital Neckar, for the treatment of calculous patients by lithotrity, 
and we have also given an abstract of the report of M. Civiale of the cases 
treated by him during the first year. This memoir was referred by the 
Academy of Sciences to a committee, and on the 26th of April last, M. 
Larrey, on behalf of that committee, reported, that without suspecting the 
accuracy of the statements made by M. Civiale, he thought it his duty to 
apply to the council of administration of hospitals to ascertain the number 
of patients sent to M. Civiale's ward, and the result of the treatment, and 
M. L. says that M. Civiale is mistaken as to the number of patients received into 
his ward. This number M. L. states to have been twenty-six, instead of sixteen 
as reported by M. C. M. Larrey further states that twenty-four of these patients 
were operated on, and that eleven have died. Several of these had undergone 
lithotrity. M. L. blames M. C. for presenting to the academy only the more 
prominent points in his practice, and he states that the number of patients who 
have died after submitting to lithotrity, is proportionally as great as those 
who die from the operation of lithotomy in the other hospitals of the capital. 
M. Larrey terminates his report with some compliments to M. Civiale for the 
zeal which he continues to display in the improvement of lithotrity, and he 
calls the attention of practitioners to the comparative results of lithotrity and li* 
thotomy. 

At the next meeting of the Academy, a letter was read from M, Civiale, in 
which this surgeon charges M. Larrey with having made several mistakes in 
his report. M. C. states, that he had received during the period stated in his 
report, but nineteen patients, of whom fourteen only had calculi; to this num- 
ber two must be added, included in M. C.'s report, and who ^ere operated 
upon in private practice. Four of the patients received had no calculus; four 
of those who had a calculus were not operated on; two who had submitted to 
the prehminary trials could not support the treatment. Thus the number ope- 
rated on was eleven, and not twenty-four, as said by M. Larrey. The error of 
the latter arose, according to M. C, 1st, from his having included in the pe- 
riod of his report four months more than was included in that of M. Civiale; 
2d, from his having considered all the patients as calculous; 3d, from his sup- 
posing all the calculous patients to have been operated on. M. Civiale avers 
that several patients whose deaths are attributed by M. Larrey to lithotrity^ 



248 QUARTERLY PERISCOPE. 

have never been operated on; others whose condition is said to have been ex- 
asperated by attempts at the operation have never been subjected to these trials; 
and finally, that a patient said to have died in consequence of cystotomy, did 
not undergo this operation. i 

In answer to this, M. Larrey referred to the documents joined to his report, 
and which were deposited with the secretary of the Academy. 



MIDWIFERY. 

71. Caesarean Operation. — Tn the Archives G^n^rales, for February last, we 
find an extract from the thesis of M. Jolly, a Parisian graduate, in which the 
author gives an account of the remarkable success of his father, a surgeon of 
Chateau-Thierry, in the performance of the Caesarean operation. He has ope- 
rated six times, five of his patients being country-women, and the sixth an in- 
habitant of the town. In all the labour had lasted at least forty-eight hours be- 
fore the operation was performed; and the waters Imd been discharged. In one 
patient only of the six no fatiguing attempts had been made bymidwives or ac- 
coucheurs to finish the labour. He always made the incision on the linea alba, 
between the navel and pubes, and divided the uterus in the same direction, 
taking care to restore it first to the perpendicular position if it was inclined. 
There was never any material haemorrhage; no patient, indeed, lost more than 
two ounces of blood. In dressing the wound he always had recourse to the gas- 
troraphy, which, instead of producing the ill consequences usually ascribed. to 
it, appeared to him always to contribute greatly to the cicatrization of the 
wound. In two of the six cases no untoward symptom whatever followed the ' 
operation, and the cure was perfected before a month expired; in two others a 
smart degree of inflammation of the abdomen supervened, but was successfully 
combated by venesection, baths, and fomentations; and the remaining two died 
evidently of metroperitonitis, one on the fourth day, the other at a later period, 
when there appeared eveiy chance of her recovering under the antiphlogistic 
treatment. Of the six infants four were born alive and survived; but two were 
dead after the operation was concluded, although they were thought to have 
been alive before it was performed. In no instance did hernia ensue; but there 
was always some prominence of the abdomen at the cicatrix, which had dimi- 
nished from six inches in length to three onl3\ These results are much more 
favourable to the operation than any previously published. 

72. Obliteration of the Vagina. — M. Lombard, of Geneva, communicated to 
the Royal Academy of Medicine, at their sitting of the 15th of March last, the 
case of a female, the mother of four children, and who when pregnant for the 
fifth time, injected into her vagina, for the purpose of exciting abortion, some 
sulphuric acid, which produced inflammation, and the obhteration of the supe- 
rior two-thirds of this organ. The woman, nevertheless, went her full time, 
and after thirty-six hours labour, an unsuccessful attempt was made to open the 
passage with the knife. The patient died. The Ceesarean section was then per- 
formed, and a dead infant found. The uterus was ruptured at its middle on the 
left side, and to the extent of four or five inches. — Revue Medicate, Jlpril, 1831. 



MEDICAL JURISPRUDENCE AND MEDICAL POLICE. 

73. On the Grinder's Phthisis.— \i has long been known that of all unhealthy 
trades, none is equal in its ravages to that of the steel-grinder. The pubhc 
attention has been for some time strongly attracted to the subject in Sheffield, 
bv the miserable fate of the workmen of that class in the town; and, in conse- 



Medical Jurisprudence and Medical Police. 249 

quence, more accurate data have been supplied on the extent of the evil than 
in regard to any other tradein Britain. The whole information hitherto col- 
lected has been thrown by Dr. Knight of Sheffield into the form of an Essay, 
of which we shall here present an analysis. 

The articles on which the Sheffield grinders are employed, are forks, awl- 
blades, fire-irons, razors, scissors, pen-knives, table-knives, large pocket-knives, 
files, joiners' tools, saws, sickles and scythes. Some of them use dry grind- 
stones only; others only wet grind-stones; others sometimes the one, sometimes 
the other. The total number in Sheffield is about 2500. They usually com- 
mence the employment at the age of fourteen, and, at this period, are, for the 
most part, raw-boned, uncouth, vigorous, hardy lads, apparently without any 
particular predisposition to pulmonary disorders. When their apprenticeship 
is concluded, in seven years, they generally proceed to work on their own ac- 
count; but some are obliged to abandon the trade during their apprenticeship, 
being unable to stand the bad effects of the dust on the lungs. During the 
war a considerable number enlisted at an early age; but now, that this outlet 
no longer exists, they usually stick to their trade throughout life, though well 
aware of its fatal tendency. 

Till the commencement of the last century, the grinders were not observed 
to be an unhealthy set of men; because they worked chiefly in the country, and 
mostly in large rooms open at the roof; they practised other departments of the 
cutlery trade at the same time, such as hafting and forging, and were conse- 
quently but a short time employed in grinding; and besides, they were often 
for months together only four or five hours a-day at work, on account of the 
scarcity of water, which alone then was used for driving the wheels. As trade 
increased, however, a greater subdivision of labour was introduced; in 1786 
the steam-engine was substituted for water-power, and the grinders gradually 
became confined entirely to this employment, at which they worked eleven 
hours a-day, in the town, and in small rooms containing eight or ten stones, and 
frequently so many as sixteen workmen. 

The consequences of this change of system on their health have been dread- 
ful. The dry-grinders die between the age of twenty-eight and thirty-two; 
those who use both dry and wet wheels die at the age of forty, or forty-five at 
the utmost; and even the wet-grinders do not survive the age of fifty if they 
remain constantly at the trade. In 1822 it was ascertained, that among 2500 
grinders of all classes, there were only thirty-five who had attained the age of 
fifty, and not above double that number who were forty-five; while among 
eighty adult fork-grinders, who use only dry stones, there was not a single indi- 
vidual thirty-six years old. The singular fact, too, appears to have been esta- 
blished, that the most industrious men were the shortest-lived, while the elderly 
men had in general led dissipated lives, so that even a combination of intem- 
perance was advantageous, simply because it drew the workman in part from 
his fatal occupation. Some further statistical facts are supplied on the subject 
by Dr. Knight's experience as a medical officer of the Sheffield Infirmary; and 
they all tend towards the same conclusion. Among 250 grinders who had been 
in-patients and out-patients in Dr. Knight's department of the service between 
1817 and 1830, 154 were received on account of pulmonary complaints; while 
among 250 persons of all other trades, 5Q only had diseases of the respiratory 
system. Of the 154 cases of pulmonary disease among grinders, 13 died while 
under treatment in the estabhshment; while of the 56 pulmonary cases from 
other trades, only one died; showing not only that in the former pulmonary dis- 
eases are more common, but likewise that they are of a worse character. As 
to the respective ages of the 250 patients of the two classes, it appears that 
among the grinders 124 were above thirty, in other trades 140; above thirty- 
five, 83 grinders and 118 general tradesmen; above forty, 40 and 92; above forty- 
five, 24 and 70; above fifty, 10 and 56-^ above fifty-five, 4 and 34; above sixty, 
and 19. 

According to Mr. Knight, the workmen almost invariably begin to suffer to» 

22* 



250 QUARTERLY PERISCOPE. 

wards the close of their apprenticeship. " Such," says he, " as are predispos- 
ed to pulmonary complaints soon beg-in to experience the injurious effects of 
grinding-i and as at that time of life they are not too old to be put to other 
trades, they occasionally leave the wheel, and thus preserve both their hves and 
their health, while there more robust companions are sacrificing- both. Grinders 
who have g-ood constitutions seldom experience much inconvenience till they 
arrive at about twenty years of ag-e. About that time the symptoms of their 
peculiar complaint beg"in to steal upon them 5 their breathing becomes more 
than usually embarrassed on slight exertions, particularly on going- up stairs; 
their shoulders are elevated, in order to relieve their constant and increasing- 
dyspnoea; they stoop forward, and appear to breathe most comfortably in the 
posture in which they are accustomed to sit at their work; namely, with their 
elbows resting- on their knees. Their complexions assume a dirty, muddy ap- 
pearance, their countenance indicates anxiet}'; they complain of a sense of tight- 
ness across the chest; their voice is rough and hoarse; their cough loud, and as 
if the air were driven through wooden tubes; they occasionally expectorate con- 
siderable quantities of dust, sometimes mixed up witli mucus; at other times 
in globular or cylindrical masses enveloped in a thin film of mucus. Haemop- 
tysis frequently occurs." The expectoration commonly becoms purulent as the 
disease advances, and is occasioually fetid. Thickening of the larynx or trachea 
also occurs, with tenderness and cough on pressure. The pulse at first rang- 
ing from 80 to 90, subsequently reaches 120. About the age of thirty the dry- 
grinders are commonly forced to relinquish their employment; and the wet- 
grinders are compelled to do so likewise about ten years later. By this time 
the dyspnosa and sense <»f choking up of the lungs are urgent; the cough is in- 
cessant; dropsy is added to the other symptoms in many; the usual symptoms of 
advanced phthisis appear; and death at last ensues, but not till after many 
months, or even years of acute suflenng. This course is occasionally modified 
by accidental circumstances, inducing- acute bronchitis, pleurisy, and peripneu- 
raony; which diseases are always severe, obstinate, and intractable. The acute 
symptoms of the grinder's phthisis may be frequently subdued by early and pro- 
per treatment; and there is no doubt that they may be even efifectually dispelled 
if the individual can quit his unlucky trade. Without this, however, the rehef 
obtained is merely temporary. 

The best treatment in the early stage consists in rest, emetics, leeches, anti- 
phlogistic regimen, diaphoretics, mercurial alteratives, and saline aperients. 
Emetics in particular seem to procure immediate and great relief. In the second 
stage leeches, cupping, various counter irritations on the chest and throat, di- 
gitalis, colchicum and squills are resorted to sometimes with advantage; and 
even in this advanced stage complete recovery may be brought about, if the 
trade is abandoned, as is shown by individuals regaining their health completely, 
and kpeping it on entering the army. 

Dr. Knight has had no opportunities of making any pathological observations 
on the state of the respiratory organs after death, as the grinders have had till 
lately a rooted aversion to morbid inspections He is inclined, however, to con- 
sider the disease as a general bronchitis merely. 

Some years ago a great deal of attention was paid by the master cutlers at 
Sheffield to the mode of preventing the deleterious effects here pointed out; 
and in consequence various contrivances were suggested for preventing the 
dust from being diffused through the apartments of the workmen. Every plan, 
however, has turned out more or less defective, and Dr. Knight says that no 
precautions are now taken. Among the methods devised two deserve mention. 
In one the wheels were enclosed in boxes, the inside of which was kept moist; 
a sufficient space was left free over the stone for the men to apply the instru- 
ment to be ground, and a set of magnets were placed over the free space to catch 
the steel dust. This device, however, was found ineffectual, because the steel 
dust only was caught, which perhaps is not the most detrimental part of it; and 
the magnets required frequent cleaning, which the workmen could not be 



Medical Jurisprudence and Medical Police, 251 

trusted to perform. The other was a simpler and more efficacious method. 
The wheel being inclosed in a box as above, a wide tube extended from the 
box to the external air; and it was found that the rotatory motion of the air 
around the wheel produced a strong- current, which carried much of the dust 
away by the chimney. This current was aided in its operation by a fan placed 
at the upper orij&ce of the chimney and moved by the steam-engine. It appears, 
however, that this ingenious plan does not remove the finer particles of dust, 
which are probably the most injurious; and the contrivance has consequently 
been generally abandoned. Dr. Knight very properly suggests that by further 
improvements, such as the establishment of proper fixed currents in the work- 
shops, and the careful removal of the previous day^s dust before the men begin 
their operations, the plan last mentioned may at length be made so far effectual 
as greatly to diminish the inconvenience; and that what remains may be coun- 
teracted by restricting the period of working. But he complains that after a few 
years of excitement, the subject no longer seems to interest either the work- 
men themselves, tlieir masters, or philanthropists at larg'e. — Ed. Med. and 
Surg. Journal, July, 1831, and North of England Med. and Surg. Journal for 
August and November, 1830. 

74. Medico-legal Researches on Arsenic. — M. Hunefeld, of Grifswald, has pub- 
lished some interesting observations on this subject, in the Archiv. fur Mediz. 
Erfahrung v. Horn, Nasse und Wagner, for September and October, 1829. 

It is known that after poisoning with small doses of arsenic, it often happens, 
that in examining the bod}', none can be found, if it has been interred some time. 
The question that naturally presents itself is, what becomes of it? The author, 
from experience, thinks that it can disappear in one of two ways. 

1st. It may combine with the tissues, and thus escape the ordinary reagents. 
In this case, M. Hunefeld treats the animal matter, supposed to contain arsenic 
with chlorine, and, bv this means, he has frequently discovered traces of poison, 
which he could not find by the ordinary reagents. 

2d. The arsenic may exhale in the form of an arseniated hydrogen gas; 
the author recommends from this circumstance, that, in disintering bodies sus- 
pected of being poisoned by arsenic, that the lid of the cofiin be not taken off 
at once, but that a hole be made first in it to avoid the deleterious effects of gas. 
— Bulletin des Sc. M^d. Jan. 1831. 

75. Poisoning loiih a Tohacco-clysier. — An interesting case of poisoning with 
a tobacco-clyster, is related by Dr. Grahl, of Hamburg, in Hufeland^s Journal, 
for October, 1831. Not having yet received that Journal, we take the follow- 
ing notice of it from the Edinburgh Medical and Surgical Journal. The subject 
of the case was a female, twenty-four years of age, who was liable to dyspeptic 
symptoms and obstinate constipation, on account of which she had been for a 
few days under the care of the relater, and with considerable advantage. One 
day the patient's niother proposed that a tobacco-clyster should be administer- 
ed, which Dr. Grahl peremptorily prohibited. Nevertheless, on the following 
day she took the advice of a female quack of her acquaintance, who recom- 
mended a clyster made with an ounce or an ounce and a half of tobacco, boiled 
for fifteen minutes in a sufficient quantity of water. In two minutes after it 
was administered, the patient was seized with vomiting, violent convulsions, and 
stertorous breathing, which gradually became weaker and weaker till she died, 
three-quarters of an hour after the clyster was administered. The following 
were the appearances remarked in the body, which was examined two days 
after death: — Great lividity of the back, slight lividity of the abdomen, retrac- 
tion of its anterior parietes, paleness of the lips, firm closure of the jaws, flexi- 
bility of the joints. The omentum very red, without gorging of its veins; the 
small and great intestines, both outside and inside, gorged with blood and red; 
and in some parts of the mucous membrane extravasated bloody patches. The 
other abdominal viscera in a natural state; the great vessels of the abdomen 



252 



QUARTERLY PERISCOPE. 



more empty of blood than usual; the stomach natural; the lungs pale red; the 
heart empty of blood in both sides; the brain quite natural, and without any 
accumulation of serosity in the ventricles. 



MEDICAL STATISTICS. 

76. Half-yearly Report of Cases in Midwifery^ which have occurred in the 
Northern District of the London and Southwark Midwifery Institution. By C. 
Waller, Esq. 





Number of 


Sex of Children. 1 


Bom 






1831. 












delivered. 


Males. 


Females. 


Alive. 


















f 32 Natural 


January. . . . 


35 


22 


13 


31 


4 


, 1 Foot 
"S 1 Premature 
L 1 Face to Pubis 














February .. 


27 


16 


11 


25 


2 


Natural 


March 


35 


18 


17 


34 


1 


5 34 Natural 
t 1 Breech 
r28 Natural 


April 


29 


12 


17 


25 


4 


< 1 Breech 

C 1 Premature 

r39 Natural 

J 1 Face to Pubis 

1 1 Foot 


Mav 


41 


20 


21 


37 


4 
















L 1 Premature 














r37 Natural 


June 


SB 


24 


15 


39 





< 1 Face to Pubis 
C 1 Case of Twins 


Total 


1 205 


112 


94 


191 


1 15 



London Medical and Physical Journal, August, 1831. 

77. Medical Statistics of Nantz. — We find in the Bulletin des Sciences Medicales, 
for January last, a brief notice of an interesting" memoir by M. Makeschal, on the 
mortality of the city of Nantz, contained in the Journal de la Section de Medi- 
cine, de la Societe Academique du department de la Loire inferieure, a journal 
we regret not yet having- received. 

The deaths from consumption in Nantz are one-tenth of the whole number, 
excluding those from epidemic diseases. The g-reatest mortality in phthisis oc- 
curs between the twentieth and fiftieth years of age. 

Of the deaths from cerebral diseases, two-thirds are adults; but from hydroce- 
phalus alone the deaths of children are to those of adults as twenty-two to 
three. 

Of 64 deaths from apoplexy and paralysis, 7 only occurred in individuals 
below fifty years of ag-e. 

Organic diseases of the heart most frequently occur after the fortieth year of 
age, in the proportion of twenty-three to six. 

The result of observations during twenty consecutive years, give the follow- 
ing as the succession of the months, arranged in the order of decreasing mor- 
tality, viz. — January, December, February, March, April, May, November, Au- 
gust, September, October, June, July. The months in the years 1827 and 
1828, owing to the influence of epidemics, follow a diflTerent order. 



Miscellaneous, 253 

CHEMISTRY. 

78. Odour of Musk. — M. Blet has found that the golden sulphuret of anti- 
mony entirely deprives musk of its odour. The kermes mineral converts the 
peculiar odour of musk into an alliaceous one. This last may be important in 
a medico-legal point of view. Sulphur alone does not produce any changes. 

79. lllcine. — At a meeting of the Royal Academy of Sciences of Paris, on the 
23d of May last, M. Deleschamps announced that he had succeeded in obtaining 
a new vegetable matter from the bark of the holley, to which he had given the 
name of ilicine, and which may be substituted for quinine in the treatment of 
intermittent fevers. 

80. Analysis of Urinary Calculi — The Medical and Physical Society of Cal- 
cutta have adopted the excellent plan of printing minutes of their monthly 
meetings, with an abstract of the papers read, and sending it to their members 
and correspondents. We have been favoured by their learned secretary, W. 
TwiNijTG, Esq. who is known to our readers by his excellent papers on oph- 
thalmology, with the minutes of their meeting of May last. We find in this the 
analysis often caiculi by Mr. Twining. Of these, five consisted principally of 
lithic acid and lithate of ammonia — two of oxalate of lime — two of oxalate of 
lime with minute nuclei of lithic acid — one had a lithic acid centre and phos- 
phate of lime exterior. 

Mr. Burnard sent to the Society thirteen calculi, five of which consisted of 
lithic acid and phosphates — four of lithates and lithic acid — one fusible — one 
fusible and oxalate of lime with a trace of lithic acid — one oxalate of lime. 

Mr. Brett presented seven calculi, four of whicli were composed of lithic 
acid and lithate of ammonia, with more or less of triple phosphate exterior — 
two of oxalate of lime with lithic acid nuclei— and one alternating, composed 
of lithic acid nucleus, thin lamina of oxalate of lime, then lithate of ammonia, 
and exterior of compact lithic acid. 

" As far as the analysis of the calculi now before the Society will enable us 
to judge,'* says Mr. Twining, '-'the urinary calculi of natives of India, appear 
to be subject to the same laws in respect to composition and formation, as 
obtain among Europeans in our own climate. Lithic acid, and lithate of ammo- 
nia, predominate In the calculi that have been yet collected in India; and we 
observe, that lithic acid, or oxalate of lime, are the most common nuclei of 
urinary calculi amongst natives. Whether the deposition of tliese sub- 
stances, originally depend on some local disease of the kidneys and urinary 
secretion, or on constitutional disorder, the lithates and oxalates appear to 
coalesce most readily so as to form the nuclei of calculi. Whereas the morbid 
excess of the phosphates, thougli frequently existing in the state of fine white 
powder, or white sand, and in most constitutions readily deposited whenever 
a nucleus is afforded, are rarely found to constitute the centre of calculi. But 
when any extraneous body is lodged for a considerable time in tlie bladder, a 
deposit of the phosphates readily takes place in preference to the lithates or 
oxalate of lime; more especially if the foreign body be rough, and the bladder 
in a state of irritation. After the deposit of those substances, lithates and oxalate 
of lime has gone on for some time, it appears to cease; but the requisites to 
form concretions of the phosphates existing, namely, nucleus and irritation, the 
exterior of many large urinary calculi are composed of those substances, which 
rarely form the nucleus." 



MISCELLANEOUS. 

81. On Gelatine as an article of Nutriment. — The discovery of M. D'Arcet, 
member of the Institute, of the means of preparing the gelatinous matter of 
bones, so as to form a cheap and wholesome article of food, has excited great 
attention in Paris. More than two years have elapsed since the discovery, and 



254 QUARTERLY PERISCOPE. 

the system of M. D'Arcet has been adopted in several of the hospitals, and 
in the Maison de Refuge pour V Extinction de la Mendicity of M. de Belleyme. 
The g-elatine has also been used in making sea-biscuits, which were used by the 
troops during- the late expedition ag-ainst Algiers. The mode of preparing 
both the gelatine and the biscuits is minutely laid down in the pamphlets pub- 
lished by M. D'Arcet. These experiments had invariably been attended with 
success; but on the 6th of June, M. Donn^, a young medical student, commu- 
nicated to the Royal Academy of Sciences at Paris, some remarks tending to 
throw a doubt on the subject. He stated, that being deeply impressed with the 
importance (particularly to the lower classes) of ascertaining whether the gela- 
tine did really possess the nutritive qualities attributed to it by M. D'Arcet, he 
resolved to go through a series of personal experiments on the subject. "With 
this view, recollecting that ten grammes of dry gelatine were stated to be equi- 
valent to half a litre (about two basins) of the best meat broth, he began by 
taking that quantity every morning with three ounces of bread, and gradually 
increased the quantity up to fifty grammes, which constituted his sole nourish- 
ment up to six o'clock every day; the gelatine was differently flavoured, so as 
to prevent its exciting any feeling of nausea or disgust. During the six days 
which this experiment lasted, M. Donne experienced a constant sensation of 
sinking and feebleness, and on the sixth day found that he had lost two pounds 
weight. The next week he substituted ordinary meat broth for the gelatine, 
taking a litre and a half (about five or six bowls,) and from four to five ounces 
of bread daily; during this week he experienced no sensation of feeble- 
ness, and at the end of it had regained a pound and a half of his lost weight. At 
the same time M. Donne tried similar experiments on two dogs, giving the one, 
gelatine mixed with a little bread, and offering the other nothing but simple 
gelatine. The former at first refused it, but at length ate daily as much as was 
equivalent to twelve or fifteen half litres of good broth. On the sixth day the 
dog had lost four ounces in weight, and was so voracious that he even greedily 
devoured some white lead prepared for cleaning plate, and during the second 
week totally refused gelatine, living only on about an ounce and ahalf of bread 
which was given him per day. He ultimately terminated the experiment by 
climbing to a great height, and taking possession of a quantity of boiled beef 
which was supposed to be out of his reach. The other dog could not be pre- 
vailed on to touch the gelatine, even after being for five days totally without 
food. M. Donne, therefore, considered it cruel to pursue the experiment fur- 
ther, and gave him his usual food. From these circumstances, M. Donne was 
induced to doubt the nutritive qualities of gelatine, and begged the Academy 
to appoint a committee to investigate the subject, which was accordingly done. 
At the succeeding meeting (13th June) M. D'Arcet addressed some observa- 
tions to the Academy on the subject alluded to by M. Donne; he stated that 
butchers' meat contained, on an average, in every 100 lbs. — Dry meat, 24 lbs.; 
water, 61; bone, 15, total, 100 lbs. Bones contain on an average — Earthy 
substance, 60 lbs.; gelatine, 30; fat, 10; total, 100 lbs. 

From this calculation it is evident that the 15 lbs. of bone contained in 
every 100 lbs. of meat would furnish 40-100 of their weight, or 6 lbs. of animal 
substance, so that 100 lbs. of meat, which now furnish but 24 lbs. of dry meat, 
might, by rendering the gelatine and fat of the bones available, supply thirty, 
or in other words, four oxen would furnish as much alimentary substance as is 
now obtained from five. With respect to the nutritive and salubrious qualities 
of gelatine, he remarked, that the committee appointed by the Faculty of Medi- 
cine, consisting of MM, Le Roux, Dubois, Pelletan, Dumeyil, and Vauquelin, 
after having given gelatine soup to forty patients and others, during a period of 
three months, came to the conclusions: — 1. That the use of gelatine was both 
an amelioration, and a source of economy in the alimentary system. 2. That 
gelatine soup is at least as palatable as the ordinary hospital soup; and 3. That 
gelatine is nourishing, easy of digestion, and wholesome, and cannot in any man- 
ner, be productive of injurious effects on the animal economy. The apparatus 
in the hospital of St. Louis is capable of preparing nine hundred soups per day; 



Miscellaneous. 255 

it has been in use twenty months, and has supplied 550,800 portions of gelati- 
nous food. Numerous reports have been made on the subject to the general 
administration of the hospitals, all of which agree in stating that the change in 
the mode of nourishment is a decided improvement? that the convalescent pa- 
tients acquire strength much mofe rapidly than before; that it is a source of 
economy highly important to the poor; that part of the meat formerly employ- 
ed in making soup may now be given to the patients, either roasted or in other 
forms; and finally, they all recommend the adoption of the system of gelatinous 
nourishment in all similar establishments. At the Hotel Dieu, 443,650 rations 
of gelatine have been furnished in fifteen months and a half; and six reports 
have been made, all of which are equally favourable with those above referred 
to. They state particularly that since gelatine has been employed, thirty killo- 
grammes of roast meat maybe given to the patients daily, without reducing the 
quality of the soup at all below its former standard. 

When M. D'Arcet had concluded his remarks, M. Gay Lussac animadverted 
in strong terms on the injustice and insufficiency of the mode of experiments 
adopted by M. Donne, which he characterized as wholly inconclusive, although 
calculated to produce a most injurious effect on the public mind, which is al- 
ways easily impressed with the idea that the poor are neglected, particular- 
ly in hospitals. He reminded the Academy that it was well known that no sin- 
gle substance was alone sufficient to support animal nature; that animals fed on 
sugar alone had died from inanition; yet it would not be pretended that sugar 
is destitute of nutritive qualities; and though the nutritive qualities of potatoes, 
taken with other food, are universally known, a dog fed wholly on that vegeta- 
ble dies in six weeks; whereas M. Donne wishes it to be supposed that because 
two dogs refused to live upon gelatine, administered alone, we know not how, 
and because M. Donne himself grew thin on a sudden adoption of simple gela- 
tine diet, the adjunction of gelatine, as an addition to, and taken in conjunction 
with animal food, is wholly without advantage. On the 20th of June, M. Donne 
replied to M. Gay Lussac, by saying that his sole object in proposing the ques- 
sion was to have it fully and fairly investigated; since if it can be established 
that gelatine does possess the nutritive qualities ascribed to it, the advantage to 
the poorer classes will be immense; whereas, on the other hand, should they be 
induced to employ the bones as a means of nutriment, when the fact may turn 
out to be that the gelatine is not nutritious, their condition is rendered more de- 
plorable than before. In conclusion, he said that he rendered full justice to the 
active and pure philanthropy of M. D'Arcet, which had induced him to make 
the greatest sacrifices both of time and money, in order to bring the gelatinous 
system to perfection. — The Journal of the Royal Institution of Great Britain, Au- 
gust, 1831. 

82. Cholera. — We had intended in the present No. to have given a summary 
of the present state of our knowledge in relation to this disease, and for this 
we have ample materials, the press having been extremely prolific in accounts 
of the progress and speculations on the nature and most successful mode of 
treating this scourge. We postponed it however for the purpose of making 
room for a review of a work which the profession have been anxiously expect- 
ing, and the sheets of which, as far as printed, we were favoured by the pub- 
lishers with a copy of. After this review, however, was actually in type, the 
completion of the work having been unexpectedly delayed, we were compelled 
to postpone the review. This occurred at too late a period to permit us to 
arrange, in proper form for publication, our notes on cholera; and we can only 
at present state, that that disease was extending its ravages at the latest dates, 
and that the most contradictory statements are given respecting every point 
relating to its mode of propagation, nature, and best method of treatment. From 
this mass of conflicting testimony, we shall in our next No. endeavour to pre- 
sent as clear a view of the subject as a looker-on, who has no preconceived 
notions in relation to the subject, may take, after a careful examination of the 
statements on both sides. 



( 256 ) 



AMERICAN INTELLIGENCE. 



Memarks on the Climate of the Lower Country of South Carolina. By Thomas Y, 
Simons, M. D. Port Physician and late President of the Medical Society. — In an 
interesting essay on malaria in the last number of this journal, by Dr. Caldwell, I 
was surprised to observe the following observations in a note. " The low lands 
of the Carolinas, and I believe also of Georgia, are much healthier now than 
they were at the close of the revolutionary war. The cause is obvious. They 
are under higher cultivation. At the period referred to, white men could not 
labour in them and retain their health. Negroes were therefore necessary. 
But they are less necessary now. Li twenty or thirty years more^ perhaps within 
a shorter period^ they will not he necessary at ally" &,c. 

It is my object in this communication to correct the error which Dr. Cald- 
well has so strangely fallen into. It is an observation of Cullen, " that there are 
more false facts than false theories in medicine," and my reading continually 
convinces me of the truth of the remark of that great physician. 

The lower country of South Carolina, in place of being more healthy, is de- 
cidedly more sickly. Many situations where large families are reared, cannot 
now be inhabited during the summer and fall, except at the imminent risk of 
life. The reasons for this change are, I apprehend, these. 1st. That a great 
quantity of trees have been destroyed for clearing land for cultivation, for fences 
to enclose the land, and in some places for fuel to supply Charleston; and 2d, 
that the reservoirs, swamps, and ponds, with which the lower country of South. 
Carolina abounds, remain stagnant, and in no manner drained. I concur with 
Dr. Caldwell, that wherever lands are well drained, and a proper dry culture is 
introduced, the healthiness of a country will be improved, and that the draining 
must be complete; but I deny that any such improvements in the lower coun- 
try of South Carolina has occurred, or is, I fear, likely to occur. There are on 
the contrary many plantations, the residence of our ancestors, which are aban- 
doned because the product of the land would not be equivalent to the expense 
of cultivation, and so far from being improved they have run to waste. 

In our lower country there are many small villages located in the pine land, 
the soil of which is barren and porous, studded with pine trees, and remote 
from any large swamps or reservoirs, and the only manner in which health is 
here preserved is the caution used in preventing a single tree to be cut down, 
or cultivation of any kind to be carried on. Wherever this rule has been de- 
viated from, the villages have become sickly. But no one thinks of residing on 
their plantations during the summer, while our elder planters and our ances- 
tors did reside on their places, thus showing that our country, in place of being 
more healthy, is actually more sickly, and in this assertion I am confident I 
will be sustained by the opinion of every medical gentleman in the lower coun- 
try of South Carolina. 

I shall now reply to the unauthorized conclusion to which Dr. Caldwell 
has arrived at, by a very illogical course of reasoning, viz. assuming false 
data. Dr. C. remarks that, " In twenty or thirty years more, perhaps 
within a shorter period, they (the negro slaves) will not be necessary at 
all. White men will do their work to greater advantage. By that condition 
6f things, the abolition of slavery in our country will be greatly facilitat- 
ed." Now this I unhesitatingly declare to be as incorrect a statement as could 
possibly be made. I am aware that some individuals from a false idea of 
philanthropy, are desirous of making the slaves free, to be miserable, even at 
the expense of the life and happiness of their fellow creatures the whites. In 



American Intelligence, 257 

theif Quixotic crusade, they will listen neither to reason or truth. They 
will not believe that the condition of our slaves are better, incomparably better^ 
than the neg-roes residing at the north, or the peasantry of Europe, and they 
gladly seize upon every opportunity of upholding- the principle of universal 
emancipation, a principle noble in the abstract, but which never perhaps can 
be fully reahzed, unless at a sacrifice too g-reat for the experiment to be made. 
Be this however as it may, it is evident that Dr. Caldwell's assertion is calculated 
to cherish the hopes of the abolitionists, and lead them to efforts which may be 
dangerous in their consequences. I therefore must ask your indulgence when 
I show the fallacy of the conclusion to which Dr. Caldwell has arrived. 

I have already asserted, and my assertion will be borne out by the testimony 
of every physician of the lower country of South Carolina, that so far from the 
country becoming more healthy, it is actually becoming more sickly, and so far 
from any improvements being made by cultivation, that many places are de- 
serted, and those plantations which are in the highest state of cultivation are too 
sickly for white persons to live on with impunity, because it is not, nor will be 
for centuries, practicable to clear off the immense reservoirs, swamps and ponds 
with which our lower country is filled. But supposing the country appro- 
priated to dry culture should be so far improved and drained, what is to be- 
come of our extensive rice fields, and the large reservoirs which are necessary 
to flow the rice fields, and which are highly important? It is admitted by Dr. 
Caldwell, that rice culture is not suited to the healthiness of a country, a fact 
by no means new, and does he expect that South Carolina will give up this im- 
mense source of wealth ? This idea is preposterous. It is evident, therefore, so 
long as rice is cultivated, so long will our lower country be sickly. Now it is 
known that during the summer and fall months, the negroes are most healthy, 
while the whites cannot live on rice plantations without early losing their lives 
or dragging out a miserable existence of disease. In short, while the negro is 
fat, glossy, and in full health, the white is pale, shrivelled, and dropsical. Many 
Europeans and northerners have attempted to reside during the summer on plan- 
tations as overseers, but have either died, or have had their constitutions broken, 
and the children who are born in the country, and live all the year on the plan- 
tations, are lazy and inactive, because their physical energies are exhausted 
from continual disease from infancy. They have immense spleens, and are pale 
and cadaverous, while the negroes who live in the country are infinitely more 
healthy than those who live in the city, and more so, I do not hazard too much 
in saying, than any class of labourers in the world. 

These facts I defy any one to contradict, and I feel fully warranted in the as- 
sertion, that the lower country of South Carolina can never be cultivated by a 
white population; that it would be to them, under such an attempt, as the Pon- 
tine marshes of Italy were to the Italians, and like that once luxuriant spot, 
studded over with villas and palaces, it would be only the scene of pestilence, 
poverty, and desolation. It is not my intention to animadvert upon the essay 
of Dr. Caldwell, but believing it important that so serious an error, coming from 
such high authority, should be corrected, I have been induced to address the 
antecedent remarks to you. 

Charleston, Sept 22, 1831. 

Notice of a Trial for Infanticide. By John Ajtdrews, M. D. (Communicated 
in a letter to R. E. Griffith, M. D.) — The trial for infanticide, the result of 
which, in your polite communication of July 20th, you expressed a desire to be 
informed of, took place last week before the Supreme Court of Ohio, setting 
in Jefferson County. 

I will briefly enumerate the medical facts, and give you the professional opi- 
nions based upon them, as they were almost the only evidence produced upon 
the trial. 

In June last, the body of an infant female negro was discovered in the vault 
of the privy upon Mr. H.'s premises. A black woman employed in the family was 

No. XVIL— Nov. 1831. 23 



258 QtTARTERLT PERISCOPE. 

charged with being the mother. She at first denied, but afterwards acknowledged 
the fact, and said it was born the day before, that being a dead child, she did not 
■wish to make a noise about it, and had laid it to one side over night, and thrown 
it into the privy about day-light that morning. This was between eight and 
nine o'clock, A. M. She was a married woman, had had several children, but 
she and her husband had been living apart for the last year. 

Being removed from the vault, and slightly washed in cold water, the body 
presented these appearances. The placenta was attached to the umbilical cord, 
both of which had a perfectly natural appearance. The size of the child was 
that of one born at maturity? its physical organization, as far as was observed, 
being also entirely perfect. The head was round, the chest prominent, the 
abdomen free from tympanitis, and every other evidence of putrefaction. About 
the anus, there was observed some meconium. On one side of the upper part 
of the windpipe, there was several, and on the opposite side one curved mark, 
as if made by the nails of the thumb and fingers of an adult hand. These Were 
confined to the cutis, had no appearance of ecchymosis about them, and were so 
like to, as to be confounded with an incision in the skin, with the point of a 
scalpel, during the examination. 

Over the left malar bone, there was a small contusion, confined to the skin, 
accompanied with slight ecchymosis, into the cellular membrane beneath. The 
entire circle might have been covered with a copper. Over the left frontal pro- 
tuberance, there was a similar contusion accompanied with about the same ge- 
neral appearances. Over the right eye-brow, there was a very small bruise, 
the size of a dime, free from any marks of hloody discolouration. Under the 
scalp, upon the pericranium, there was an extensive ecchymosis, extending 
between the fontanelles, and laterally half way down the parietal bones. It 
was posterior to both the external marks, and having no apparent connexion 
with or dependance upon them. The dura mater was closely adherent to the 
under surface of the cranial bones; the venous vessels of the pia mater en- 
gorged with blood; the substance of the brain presented no traces of lesion; 
the examination of the encephalon, however, was by no means so minute as 
was desirable. Within the trachea, no change of colour in the raucous lining, 
nor other morbid change, was noticed. 

On opening the thorax, its viscera presented a natural aspect. The lungs 
were reddish; when cut into, dark blood appeared in spots, and might be 
squeezed from the incision. In cutting through the root of one lung, consider- 
able dark blood ran from the pulmonary vessels. The entire lung, and sections of 
it, floated lightly upon water of the temperature of the atmosphere in the 
shade, both before and after compression in the hand. By the mode of open- 
ing the thorax, the form of the diaphragm was lost. The abdominal viscera 
were healthy, and free from the slightest marks of putrefaction; the colon con- 
tained some meconium; the bladder was rather softer to the touch than when 
it has been known to contain urine, but was not examined within. The vena 
umbilicalis contained a little blood. 

Drs. Judkins, Leslie, Dickson, and Andrews, being sworn, testified to the 
above facts. From them, they had no doubt of the child's having irea^Aec?,- but 
this might, and did frequently occur, before the delivery even of the head, and 
was of every day's occurrence, when the head only had passed the os externum, 
the shoulders and body being retained within the organs of the mother. 

As to the question, whether the death of the child was caused by violence^ 
Dr. Judkins was of opinion, that the violence producing the marks upon the 
head, was sufficient to produce death, which it had done, as he supposed, by 
concussion of the brain. Dr. Leslie entertained the opinion that death had 
been produced by strangulation, as he had seen as severe injuries upon the 
head of a new-born child from the application of the forceps, without causing 
death. 

Drs. Dickson and Andrews, regarded all the morbid appearances as equivo- 
cal; that upon the face and os-frontis were evidently the result of force applied 



•American Intelligence, 259 

during- the life of the child, but even when then made, they were not sufficient 
to cause death. They exhibited no lesion of any vital organ. The large ec- 
chymosis might readily occur in the delivery, without any agency on the part 
of the mother. Cerebral concussion might have taken place, and even caused 
the death of the child, but this could not be demonstrated. Concussion left no 
trace behind it. Strangulation was not to be assigned as the cause of death, 
in the absence of those traces which it leaves upon the body, as we are told, in 
every case. It was quite possible, in their opinion, for all these marks to have 
been produced by the attempt of the mother to deliver the body of the child, 
rendered difficult sometimes by the great size of the shoulders, or the abate- 
ment of uterine contraction, occurring singly or together. It is not uncommon 
for women, in the pangs of labour, to throw their body in many postures, and 
to attempt to assist themselves by the use of their hands. On the whole, the 
marks upon the body, they thought, should be looked upon as strongly suspi- 
ciouSy but as wanting confirmation from other sources, to make out the murder. 

The other evidence brought forward not being pointedly confirmatory, the 
court stated to the jury that they ought not to convict in a case of this kind 
without the most unequivocal proofs of guilt, and they did not hesitate to say, 
in the present case, that the evidence was insufficient to convict. 

The Jury acquitted the prisoner. 
Steubenvilky Ohio, Oct. 1831. 

Case of Great Abdominal Disorganization — Death by Apoplexy. By Richard 
D. MooKE, M. D. one of the House Physicians of the Philadelphia Alms-house. 
— Martin M'Donna, aged thirty-seven years, tall, remarkably pale, and some- 
what emaciated, was admitted into the men's medical ward of the Philadelphia 
Alms-house, on the afternoon of the 14th of October, 1831. He was so much 
exhausted, that I did not deem it proper to fatigue him by asking any ques- 
tions regarding the history of his disease, but ordered him to bed, and per- 
mitted him to rest, giving him occasionally a drink of wine and water. His 
friends could give me no satisfactory account of him — they only know that he 
had been complaining for several months. 

I saw him again in a few hours; he had had some sleep, felt more composed, 
had little or no pain, his skin warm, his pulse a little fuller, but still weak and 
very compressible, tongue moist and red in the centre, edges pale. I now at- 
tempted, but without success, to obtain from him a satisfactory history of his 
case; he became fatigued, and appeared to be confused in his memory; 1 could 
only learn that he had had a dysentery for more than two months, that he had 
suffered much on going to stool, and sometimes he would be compelled to go 
as often as thirty times in the twenty -four hours; discharges very small, and oc- 
casionally mixed with blood; that he was principally troubled at night. I could 
learn nothing of the first symptoms: the only object, therefore, I have in draw- 
ing up this case, is to represent the manner in which he died, and the post 
mortem appearances. 

7 o'clock, P. M. He was now in much pain; his bowels open every twenty 
or thirty minutes, discharges very offensive, and consisting of mucous tinged 
with blood, and a few dark collections resembling slate dust. Ordered injec- 
jections of mucilage made of Ulmus americana, with tinct. opii, gtt. xxx. this 
to be repeated every hour, and every second hour add sulph. zinc. grs. iv.; his 
abdomen rubbed with vol. linim. every thirty minutes; wine whey every hour, 
and as a common drink, viz. R- Ulnn. americ. ^i.; pulv. g. acac; pulv. tragac, 
pulv. salep, aa. ^i. ; sacch. alb. §ss. Boiling water, a pint; half given every hour. 
10 P. M. Easy. Blister to abdomen, extending over the region of the colon. 

^ 15th. This morning felt better, and expressed a wish for something to eat; 
his pulse very weak and small; skin pale, and disposed to be cold; his tongue 
dry, and his voice feeble. Continued the injections, with increase of tinct. opii, 
gtt. xl. ; the discharges not so frequent last night as usual, nor were they so 
painful. Continue mucilaginous drink and wine whey as before, and a table- 



260 QUARTERLY PERISCOPE. 

spoonful every two hours of the following: — R. Cret. prep, ^iii.; tinct. opii, 
511.; simp, syrup, gss.; aqua cinna. ^i.; mucilage acac. ^iv. 3 o'clock, P. M. 
Felt a little head-ache, and became drowsy. Ordered warm foot-bath. 

16th. This morning no head-ache; his pulse the same as yesterday; face still 
pale, though some fever, skin being hot and dry; tongue a little moist. Stop 
wine whey, and continue the treatment of yesterday; bowels opened eight or 
nine times through the night; pain not so great. 7 F. M. Skin cold; pulse sink- 
ing; could not speak aloud. Mustard to extremities, and hot brandy toddy oc- 
casionally. 

17th. A little better; discharges not so frequent; pulse a little fuller, but 
weak; skin moist, and warm; tongue moist. Ordered to continue same treat- 
ment with a spoonful of the essence of beef every three hours. 

18/A. Slept tolerably well last night; this morning very weak; discharges in- 
creased, or rather the desire to evacuate, the matter discharged very offensive, 
and of dark watery consistency. Ordered pulv. opii, grs. vi. ft. pil. introduced 
into rectum. Continue same treatment, suspending the injections until the 
pill had been discharged. 3 o'clock, P. M. Had an apopleptic fit which conti- 
nued for fifteen minutes. It returned at 4, or a little after, and he died in a few 
minutes. 

Post mortem examination ^ twelve hours after death. — Head. A good deal 
of congestion in the scalp, principally venous. Dura matter healthy, but 
distended on the right side, caused by a coagulation of effused blood between 
the membrane and the arachnoid, extending from the middle of the frontal 
bone to the right leg of the lambdoidal suture, and from the petrous portion of 
the temporal bone to the sagittal suture. This coagulum was near a quarter of 
an inch thick; the blood, dark venous. Upon a minute examination with the 
naked eye, no rupture of any vessel could be discovered. The substance of 
the brain a little congested. The ventricles half filled with bloody serum. The 
cerebellum and medulla oblongata, healthy. 

Thorax. Contents of this cavity healthy. 

Mdomen. The peritoneum much thickened, and of a dirty white colour; that 
portion covering the colon hard, and in some of its folds contained a fluid resem- 
bling milk. 

Stomach. Mucous membrane thickened, and in places intensely red, particu- 
larly the cardiac extremity. Contents of glairy mucus. 

The duodenum pretty much as the stomach, as regards its colour, but the 
mucous membrane was not thickened. The small intestine healthy, with the 
exception of the lower extremity, which was inflamed. Contents yellow, and 
not quite the consistence of soft soap. 

Colon. So entirely changed, as scarcely to be recognised, being in some 
places half an inch thick, and in others one or two lines more; its feel was hard 
and indurated, resembling gravel, under the peritoneum. It was opened its 
whole length; the mucous membrane of the upper portion, about two-thirds, 
thickened three lines, the remaining third was entirely disorganized, and must 
have been insensible before death, or nearly so. The upper portion contained 
ulcers, some as large as a quarter of a dollar, elevated, and of a dark gray colourj 
smell being offensive; the lower portion of the colon, and the upper portion of 
the rectum, resembled very much an ulcerated cancer. In dissecting the coats 
thus thickened, I found several tubercles, having every appearance of recent tu- 
bercles of the lungs; some were softened and contained pus. 

The liver was of the natural size, but tuberculated near its surface, not much 
injected; gall-bladder filled with bile, very thin, and of a greenish colour; the 
coats of the bladder healthy. 

Spleen. Enlarged to near twice its natural size, softened to the consistency 
of soft soap. 

Pancreas hard, and changed in colour, being darker than natural. 

Kidneys and urinary bladder healthy. 



American Intelligence. 261 

Cast of Aneurism of the Brachial Artery^ cured hy Compression. By J. W. 
Heustis, M. D. of Cahawba, Alabama. — On the 27th of August, I was called 
to visit the wife of M. M. who was represented as having* a swelling or rising on 
the arm, in consequence of bleeding. On arriving, I found that a large and 
diffused aneurism had formed at the bend of the arm. The tumour occupied 
a diameter of about three inches, with a projecting pulsating apex, over which 
the skin was extremely thin, and through which the blood could be distinctly 
perceived whizzing and thrilling at every pulsation. The pain of the limb 
was excessive, so that for the last three or four days, sleep had been entirely 
prevented. The history of the case was as follows: — The woman was in the 
advanced stage of pregnane;^, and to relieve the usual unpleasant symptoms oc- 
curring on such occasions, recourse was had to venesection. The operation was 
performed by a neighbouring farmer, an old gentleman, destitute of scientific 
knowledge, but whose experience in that line had been considerable, and 
hitherto successful. The nature of the accident, however, remained unknown; 
nor, although there was considerable diflicidty in stopping the bleeding, was it 
supposed that any alarming or extraordinary occurrence had taken place. The 
external orifice healed, and the woman, who was in the lower circumstances 
of life, resumed her usual domestic occupations, which were rather laborious 
and fatiguing. In a few days, a throbbing tumour made its appearance at the 
place where the operation of bleeding had been performed. For several weeks 
this produced but little uneasiness, and therefore received but little attention. 
At length, however, from a small, compressible, circumscribed tumour, a dif- 
fused hardness and swelling took place, occupying nearly the whole bend of 
the arm. Great pain and lameness now ensued, and the limb was deprived of 
the power of muscular exertion. 

Such was tlie situation of the patient when 1 saw her. I immediately ex- 
plained the nature of the case and accident, and informed the family of the ne- 
cessity of an immediate operation. The patient wept and shuddered at the cruel 
alternative, though had 1 been urgent, she would have finally submitted. She 
was within a few days of her confinement, and it was dreaded that an operation 
at the time might have had an unfavourable effect upon her situation. I therefore 
told them that there was another, though a doubtful expedient; that no injury 
could result from its trial, although I apprehended that the case v^'as too far ad- 
vanced to admit of any permanent relief being obtained in any other manner 
than by taking up the artery.- At least it was hoped that time might be gain- 
ed, so as to postpone the operation till after the accouchement. The expe- 
dient proposed was compression; this was, therefore, acceded to, though on 
the part of the husband with the apprehension, that the expense of another vi- 
sit, and an operation, must be finally submitted to. 

I now proceeded to make compression on the aneurism and brachial artery, 
in the following manner. I took two twelve and a half cent pieces, and a twen- 
ty-five cent piece, and wrapped them in a rag, so as to prevent their slipping. I 
then made a thick linen compress, and wet it with a solution of sugar of lead; 
this, with the silver next the tumour, I applied over the aneurism, and secured 
by a bandage, as in cases of tying the arm after ordinary venesection, but mucli 
firmer and more securely, by repeated turns of the bandage above and below 
the elbow. Having appUed the necessary degree of pressure in this manner 
to the aneurism, I proceeded also to make a degree of compression upon the 
brachial artery; for this purpose, another thick compress, four or five inches in 
length, wet with the saturnine solution, was laid alongthe course of the artery, 
andbound down with some degree of firmness by numerous turns of a tolerably 
broad bandage. This last application was for the purpose of diminishing the 
impetus of blood into the aneurismal tumour. Upon applying my fingers to the 
radial artery, I found that its strength and force was considerably lessened. I 
now left the patient, with directions to see that the bandage did not become 
too loose, and if so, to readjust it with such a degree of tightness as she could 
endure without much pain. I neither saw nor heard from the patient till the 

23* 



262 QUARTERLY PERISCOPE. 

expiration of a month. I then saw her husband, who expressed many acknow- 
ledg-ments, stating that my directions had been faithfully followed, and with the 
most fortunate success; that the swelling had almost entirely disappeared; and 
that the pain of the arm had ceased; that his wife had commenced using her 
hand, and considered herself almost completely well; although for fear of a re- 
turn of the aneurism, the bandage was still retained. 

I had previously found the efficacy of pressure, in a wound of an artery from 
bleeding. This happened in my own practice, in the case of a negro woman. 
The scarlet arterial blood flowed out per saltum. With some alarm I was in 
haste to tie up the arm, which I did with a compress over the wounded vessel 
in the manner above described. A firm pressure was in this manner applied, 
until the orifice had healed; which it did in the ordinary time after vesication, 
without any disposition to the formation of an aneurism.* 

The manner in which pressure operates in the cure of aneurism, appears to 
admit of easy explanation. It has been proved by experiment and observation, 
that in tying an artery a coagulum of blood is found immediately behind the li- 
gature, filling up the calibre of the artery, so that were the ligature removed 
after the formation of this coagulum, no haemorrhage would or could take place. 
Now in the case of a wound or rupture of an artery, the blood escapes from the 
vessel, and continues to distend the sheath, and cellular substances surrounding 
it, forming a coagulum exterior to the wounded artery, but of no avail in pre- 
venting the exit of arterial blood. If, however, the force of the blood can be 
impeded, and its gush from the wounded orifice suppressed, a coagulum is 
found in the immediate vicinity of the wound, and an opportunity thereby gi- 
ven for the healing of the latter. 

Although several cures of compression have been related in cotemporary 
journals, still such instances are looked upon as extraordinary, and rather acci- 
dental, and not sufficient to warrant the practice as being generally applicable 
and expedient. From the cures, however, that have been effected in this man- 
ner, I think we are fully and more than authorized in its employment, in all 
cases of brachial and popliteal aneurism, or whenever the contiguity of a bone 
affords sufficient resistance for its application. It is true, that in the hands of 
ignorance and incompetence, such practice might be productive of serious and 
dangerous consequences; but for sacrilegious assumption and intrusion, licensed 
and unlicensed butchery and murder, this advice is not intended; the field of 
their operation is already sufficiently extensive, without opening new avenues 
for death. 

In the Philadelphia Journal of Medical and Physical Sciences, No. 4, new se- 
ries, p. 363, the reader may find a variety of ingenious contrivances for making 
compression in cases of brachial aneurism, by W. B. Fahnestock, M. D. and among 
others a kind of truss, fitted to the arm with an elastic steel spring, on the prin- 
ciple of the common truss for scrotal hernia. Dr. F. reports a case of brachial 
aneurism successfully treated by the application and use of this machine. A 
contrivance of this kind may be found advantageous, although I have experi- 
enced no difficulty in retaining to its place, and with sufficient accuracy and 
firmness, the common bandage previously mentioned. 

Treatment of Ununited Fracture with the Seion.— In a former No. of this 
Journal, (Vol. VII. p. 267,) we gave a summary of the cases of ununited frac- 
ture treated by the seton, to be found in the works within our reach at the 
moment. Our valued collaborator. Dr. A. F. Vache, of New York, writes to us 
that in addition to the cases there enumerated. Dr. Mott has treated eleven 
cases of ununited fracture by that remedy. Of these, three were of the os 
femoris, three of the tibia, and five of the humerus. In all of these it succeeded 

* We have had a case entirely similar to this; and after much considei-atlon we have been led to 
doubt, fi-oni the i-eeult, whether the artery was actually wounded— the only evidence being the colour 
of the blood and its flowing per saltum. The patient was suffering extreme agony from rheumatism of 
the heart, and in that disease it is not, we suspect, very unconunon, when a vein is opened, for the 
Mood to exhibit the ferterial colour and to flow per saltum.— £</. 



American Intelligence, 263 

perfectly, except in three of the last mentioned, and which were afterwards 
cured by sawing* off the ends of the bone. 

We have also recently met with, in the seventh volume of the New Eng^land 
Medical Journal, an account of a case of ununited fracture of the humerus, 
successfully treated by the seton, by Robekt Thaxteb. 

Operati(yn of Lithotomy. — This operation has been performed on the venera- 
ble Chief Justice of the United States, by Professor Phtsick, with his usual 
skill. The operation was somewhat protracted, from the immense number of 
calculi, between eight hundred and one thousand, contained in the bladder. 
These calculi varied in size from that of a pea to that of a pin's head. We are 
happy to announce that at the present moment, two weeks siRce the operation, 
the patient is doing extremely well, and there is every prospect of his valuable 
life being prolonged many years. We have been promised the details of the 
case for a future number. 

GoupiVs Exposition of the Principles of the New Medical Doctrines. — We con- 
gratulate the profession on the appearance of Dr. Nott's translation of this 
work. A review of the original will be found in Vol. Vlll. p. 156, et seq. 

On Baths and Mineral Waters. — An elaborate work on baths and mineral 
waters, by Dr. John Belx, has just been published. We received the work too 
late to be able to do more than just glance at its contents, but we know that the 
author has paid great attention to the subject, and have no doubt that he has 
collected a large amount of valuable and interesting information in relation to it. 

Dr. Peixotto^s Address. — We have read with great pleasure the address deli- 
vered before the Medical Society of the city and county of New York, on the 
25th of July, 1831, by D. L. M. Peixotto, M. D. President of the Society. The 
learned author gives an interesting though brief sketch of the medical history 
of the state of New York, and offers some judicious suggestions for the im- 
provement of the condition of the medical profession. 

Faraday's Chemical Manipulation. — An edition of this work, with notes and ad- 
ditions by Dr. J. K. Mitchell, has just been issued by Messrs. Carey & Lea. We 
have met with no other work containing such a mass of useful information on 
the practice of experimental chemistry. It is an invaluable laboratory companion. 

Essays on the Materia Medica. — Mr. G. W. Carpenter having been fre- 
quently called upon by his medical friends for copies of Jiis papers published 
in the Philadelphia Journal of the Medical and Physical Sciences and in this 
Journal, has been induced to republish them, with an account of the new proxi- 
mate principles, the popular remedies lately introduced into practice, the for- 
mulae for their preparation, &,c. &c. The whole are comprised in a small vo- 
lume, which will no doubt be an acceptable present to the country practitioner. 

Louis on Gastro-Enteritis. — Dr. F. M. Robertson, of Augusta, Georgia, has 
in preparation a translation of this interesting work. 

University of Pennsylvania. — At an adjourned meeting of the trustees, held 
October 21, 1831, the following report was made, and the resolution attached 
thereto adopted, with instructions to the secretary to communicate a copy of 
the same to Professor Physick, and to the medical faculty. 

University of Pennsylvania^ 21st October, 1831. 

The committee to whom was referred, on the 14th inst. the resolutions of 
the medical faculty, respecting the resignation of Professor Physick, fully co- 
inciding with the views and feelings expressed by the faculty, beg leave to re- 
commend to the board of trustees the adoption of the following resolution: — 



264 QUARTERLY PERISCOPE. 

Resolved, that in consideration of the important services rendered to the Me- 
dical Department of the University by Professor Philip Stng Phtsick, in the 
chair of Surg-ery as well as of Anatomy, during- a period of twenty-six years, 
and for the purpose of continuing his connexion with the school, to the fame 
and usefulness of which he has so larg-ely contributed, there be conferred on 
the said PaiLip Syng Phtsick, the honorary appointment of Emeritus Profes- 
sor of Surg-ery and Anatomy in this University. 
From the minutes. 

(Signed,) JAMES C. BIDDLE, Secretary, &c. 

Boylston Medical Prize Questions.— The Boylston Medical Committee of 
Harvard University, give notice that the following Prize Questions for the year 
1832, are before the public, viz. 

1st. *' What is the cause of Fistula Lachrymalis, and what is the best mode of 
treating the disease ?" 

2d. '* What are the circumstances in which the drinking of cold water in hot 
weather proves injurious? What are the diseases which arise from this cause, 
and what is the best mode of treating these diseases?" 

Dissertations on these subjects must be transmitted, post paid, to Johk C. 
WAPvREif, M. D. Boston, on or before the first Wednesday of April, 1832. 

The following questions are now offered for the year 1833, viz. 

3d. *' The History of tlie Autumnal Diseases of New England.'* 

4th. *' What insects of the United States, and particularly in the northern 
part, are capable of inflicting poisonous wounds? The phenomena of such 
wounds, and the best mode of remedying their ill consequences?" 

Dissertations on these subjects must be transmitted as above, on or before 
the first Wednesda}'- of April, 1833. 

The author of the successful Dissertation on either of the above subjects, 
will be entitled to Fifty Dollars, or a Gold Medal of that value, at his option. 

Each Dissertation must be accompanied with a sealed packet, on v/hich shall 
be written some device or sentence, and within shall be enclosed the author's 
name and place of residence. The same device or sentence is to be written on 
the dissertation to which the packet is attached. 

All unsuccessful dissertations are deposited with the secretary, from whom 
they may be obtained if called for within one year after they are received. 

By an order adopted in the year 1826, the Secretary was directed to publish 
annually the following votes, viz. 

1st. That the Board do not consider themselves as approving the doctrines 
contained in any of the dissertations to which the premiums maybe adjudged. 

2d. That in case of the publication of a successful dissertation, the author be 
considered as bound to print the above vote in connexion therewith. 

Boston, August 10th, 1831. GEO. HAY WARD, Secretary. 

Medical College of South Carolina. — Dr. E. Gebdik-gs has been elected Pro- 
fessor of Pathology in this institution, and Dr. Wagjter Professor of Surgery, 
in the room of Dr. Ramsat, resigned. 

University of Maryland. — Dr. T. H. Wright has resigned the Professorship 
of Anatomy in the medical department of this university, and Dr. E. Geddistgs 
of Charleston has been elected to fill that chair. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



COLLABORATORS. 



Jacob Bigkxow, M. D. Professor of 
Materia Mediea in Harvard Univer- 
sity/, Boston. 

EnwAnn H. Bahtojt, M. D. of St. 
Francisville, Louisiana. 

Waitkr Chanxing, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

John Rebman Coxe, M. D. Professor 
of Materia Mediea and Pharmacy in 
the Univej'sity of Pennsylvania. 

William C. Daniell, M. D. of Savan- 
nah, Georgia. 

William P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 

S. Henkt Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of S. Carolina. 

C. Drake, M. B.ofNeiu York. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

Robert Dunglison, M. D. Professor of 
Physiology in the University of Vir- 
ginia. 

GouvEiiNEUR Emerson, M. D. of Phila- 
delphia. 

Thojias Fearn, M. D. of Alabama. 

John W. Francis, M. D. Professor 
of Obstetrics and Forensic Medicine 
in Rutgers Medical College, N. York. 

E. Gedbings, M. D. Lecturer on Anato- 
my and Surgery, Charleston, South 
Carolina. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

R. E. Grifeith, M. D. Lecturer on Ma- 
teria Mediea and Pharmacy in the 
Philadelphia School of Medicine. 

E. Hale, M. D. of Boston. 

Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 

Isaac Hats, M. D. one of the Surgeons 
of the Pennsylvania Infirmary for 
diseases of the Eye and Ear. 

George Hat ward, M. D. of Boston. 



Thomas Henderson, M. D. Professor 
of the Theory and Practice of Medi' 
cine in the Columbian College, DiS' 
irict of Columbia. 

William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer^ 
siiy of Pennsylvania. 

Datid Hosack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Bulgers Medical College, New York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson^ M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

C. B. Matthews, M. D. of Philadel- 
phia. 

Valentine Mott, M. D. Professor of 
Pathological and Operative Surgery 
hi the College of Physicians and Sur- 
geons, New York. 

James Moultrie^ Jr. M. D. of Charles- 
ion, S. C. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Dart- 
7nouth College, New Hampshire. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Syng Puysick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. B.Professorof 
the Theory and Practice of Medicine 
in the University of Maryland. 

D. L. Rogers, M. D. of New York. 
Thomas Sewall, M. D. Professor of 

Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

A. F. Vache, M. D. of New York. 

John Ware, M. D. of Boston. 

John C. AVarren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, Philadelphia. 

N. W. WoRTHiNGTON, M. D. ProfcssoT 
of Materia Mediea in the Columbian 
College, District of Columbia. 

Thomas H. Wright, M. D. Physician to 
the Baltimore Aims-House Infirmary. 



TO READERS AND CORRESPONDENTS, 



Professor Mott*s and Drs. Hail and Hopkiistsox's communications will be 
inserted in our next. Other communications have been received, and are under 
consideration. 

The following- works have been received: — 

Lithographic plate of the Cerebro-spinal Axis of Man, with the Origin and 
first Division of its Nerves, with explanations. From the French of M. Makec, 
M. D. P. Lecturer on Anatomy and Operative Surgery, &c. at Paris. Trans- 
lated and revised by J. Pancoast, M. D. (From Mr. P. Aiicora.) 

A Discourse on the Epidemic Cholera Morbus of Europe and Asia; deliver- 
ed as an Introductory Lecture, at the College of Physicians and Surgeons in 
the City of New York, Nov. 9, 1831. By Joseph Mather Smith, M. D. Profes- 
sor of the Theory and Practice of Physic and Chnical Medicine. New York, 
1831. (From the author.) 

The Book of Analysis, or a New Method of Experience, whereby the induc- 
tion of the Novum Organon is made easy of application to Medicine, Physiology, 
Meteorology, and Natural History; to Statistics, Political Economy, Metaphy- 
sics, and the more complex departments of Knowledge. By Tweedy Johw 
Todd, M. D. of the Royal College of Physicians of London, &c. &c. London, 
1831. (From the author.) 

Papers relative to the disease called Cholera Spasmodica in India, now pre- 
valUng in the North of Europe. Printed by authority of the Lords of his Ma- 
jesty's most honourable Privy Council. London, 1831, (From Dr. James Clajk.) 

H. M. J. Desrueeles Doctor's der Medicin, Wundarztes am Militairhospi- 
tale fUr den Unterricht zu Val-de-Grace, Mitgleides der Medicin. Nacheifer- 
ungsgesellschaft zu Paris, der Societat der Wissenschaften, des Ackerbaues 
un der KUnste zu Lille, zu Metz und Rennes, Abhandlung Uber den Keichhus- 
ten nach den Grundsatzen der physiologischen Lehre verfafst. Eine von der 
medicin. praktischen Gesellschaft zu Paris am 26. August 1826 gekronte 
Schrift. Aus dem Franzbsischen Ubersetzt und mit Anmerkungen begleitet 
von Gerhard von dem Busch, Doctor der Medicin und Chirurgie, ausuben- 
dem Arzte zu Bremen, der medicinisch-chlrurgischen Gesellschaft zu Philadel- 
phia, der Gesellschaft schwedischer Arzte zu Stockholm, undderJenner'schen 
Gesellschaft zu London Ehrenmitgliede und Mitgliede. (From Dr. Busch. ) 

Der epidemische Brechdurchfall, beobachtet zu Nishni-Nowgorod, von J. 
G. Lindgren, Dr. Med. (From Dr. Busch.) 

Medicinisch-Chirurgische Zeitung, for April and May, 1831. (From Dr. Von 
dem Busch.) 

Journal de? Ch'u^urgie und Augen-Heilkunde. Herausgegebcn ron C. F. 

24* 



272 TO READERS AND CORRESPONDENTS, 

V. Graefe and Ph. V. Walther. Band XIV, Heft 4, und Band XV, Heft 1, 2, 
and 4. (In exchange.) 

Heidelberg-er Klinische Annalen. Band VII. Heft 1 and 2. (In exchange.) 

Litterarische Annalen der gesammten Heilkunde. Herausgegeben von J. F. 
C. Hecker. December, 1830, and January, February, March, April, May, and 
June, 1831. (In exchange.) 

Bibliothek for Lseger, for 1830, and No. I. for 1831. (In exchange.) 

Archives Generales de Medecine, for August, September, and October, 
1831. (In exchange.) 

Annales de la Medecine Physiologique, for June and July, 1831. (In ex- 
change.) 

Transactions Medicales, for August and October, 1831. (In exchange.) 

Revue Medicale, for August, September, and October, 1831. (In exchange.) 

Journal de Chimie Medicale, de Pharmacie, et de Toxicologic, for Septem- 
ber, October, and November, 1831. (In exchange.) 

Journal Hebdomadaire, for August, September, and October, 1831. (In ex- 
change.) 

Gazette Medicale, for September, October, and November, 1831. (In ex- 
change.) 

Bulletin des Sciences MeJicafes, February, March, 1831. (In exchange.) 

The London Medical and Surgical Journal, for September and October, 1831. 
(In exchange.) 

The London Medical and Physical Journal, for September and October, 1831. 
(In exchange.) 

The Medico-Chirurgical Review, for October, 1831. (In exchange.) 

The London Medical Gazette, for September, 1831. (In exchange.) 

For the gratification of our contributors, we present references to >he 
works, received during the last three months, in which their communications 
are noticed. 

Professor Physick's Case of Obstinate Cough cured by Excision of the Uvula, 
is noticed in the Medicinisch-Chirurgische Zeitung, for May last. 

Professor Chapman's Thoughts on the Pathology of Icterus, his Anomalous 
Cases of Dropsy, his Remarks on the influence of Mercury in the production of 
Liver Complaints, and his Observations on the use of Tobacco in Croup, are 
noticed in the Medicinisch-Chirurgische Zeitung, for May last. 

Professor Dewees's paper on Ergot, is noticed in the Medicinisch-Chirurg- 
ische Zeitung, for May last. 

Professor Mott's Case of Ligature of the Carotid for Aneurism of the Arte- 
ria Innominata, is noticed in the Bibliothek for Lseger, No. 3, 1830; his Case 
showing the State of the Circulation of the Head after one Carotid is tied, and 
his Case of Axillary Aneurism, are noticed in the Archives Generales, for Oc- 



TO READERS AND CORRESPONDENTS. 273 

tober last; and his Case of Lig-ature of the Common Iliac, is noticed in the Me- 
dicinisch-Chirurgische Zeitung", for May last. 

Professor Hoknek's Case of Ozena is copied in the Bulletin des Sciences 
Medicales, for February last; his Experiments on the Mucous Membranes, and 
his Observations on some points of Pathology, are noticed in the Medicinisch- 
Chirurgische Zeitung, for May last. 

Professor Musset's Case of Aneurism by Anastomosis, is noticed in the Bul- 
letin des Sciences Medicales, for February last, and in the Bibliothek for Lse- 
ger, No. 3, 1830. 

Dr. Jackson's Alms-house Reports are noticed in the Medicinisch-Chirurg- 
ische Zeitung, for May last. 

Dr. Jacksok's paper on Rhubarb in Haemorrhoids, is noticed in the Bulletin 
des Sciences Medicales, for February last; and his Observations on Mercurial 
Inhalations, are noticed in the Medicinisch-Chirurgische Zeitung, for May last. 

Dr. Randolph's Case of Amputation of the Lower Jaw, is noticed in the 
Bibliothek for Lseger, Nos. 2 and 4, 1830. 

Dr. Mitchell's memoir on Rheumatism, is noticed in the London Medical 
and Physical Journal and London Medical and Surgical Journal, for September 
last, and in the London Medical Gazette, for October last. 

Dr. Peirce's Case of Cancer is noticed in the London Medical and Surgical 
Journal, for September last. 

Dr. Lehmak's Case of Spontaneous Luxation of Humerus, is noticed in the 
Bibliothek for Lseger, No. 2, 1830, and in the Medicinisch-Chirurgische Zei- 
tung, for May last. 

Dr. Fahnestock's Remarks on the use of Rhus Glabrum in Mercurial Saliva- 
tion, are noticed in the Bibliothek for Lseger, No. 2, 1830; and his Observa- 
tions on the use of Compound Tincture of Benzoin in Burns, are noticed in the 
Bulletin des Sciences Medicales, for February last. 

Dr. Gatlord's Case of Intussusception is noticed in the Bibliothek for Lse- 
ger. No. 3, 1830. 

Dr. Stuachan's Case of Extirpation of Scirrhus Cervix Uteri, is noticed in the 
Bibliothek for Lxger, No. 3, 1830. 

Dr. SxMONs's Case of Fungous Hsematodes cured by Pyroligneous Acid, is 
copied in Grsefe and Walther's Journal, No. 4, Vol. XIV. 

Dr. Ware's Case of Sea-sickness, is noticed in the Bibliothek for Lseger, No. 
3, 1830. 

Dr. Moore's Case of United Twins, is noticed in the Bibliothek for Lsegerj 
No. 3, 1830. 

Dr. Hendersgn's Case of Diseased Bones cured by Arsenic, is noticed in the 
Bulletin des Sciences Medicales, for February last. 

Dr. Faust's Observations on Endosmose and Exosmose, are noticed in the 
Bulletin des Sciences Medicales, for March last. 



274 TO READERS AND CORRESPONDENTS. 

Dr. Emerson's Medical Statistics of Philadelphia, are noticed in the Medi- 
cinisch-Chirurgische Zeitung", for May last. 

Dr. White's Case of Ligature of the Internal Iliac, is noticed in the Medi- 
cinisch-Chirurgische Zeitung, for May last. 

Dr. Ives's Case of Poisoning by Cantharides, is noticed in the Medicinisch- 
Chirurgische Zeitung, for May last. 

Dr. Hosack's Remarks on the various methods employed for the Removal of 
the Tonsils, are noticed in the Medicinisch-Chirurgische Zeitung, for May last. 

Dr. Washikgton's Case of Gun-shot Wound, Dr. Moore's Remarks on the 
efficacy of Volatile Alkali in cases of Snake bites. Dr. Moultrie's Observa- 
tions on the Lymph, Dr. Pendleton's paper on Superfoetation, and Dr. Coie's 
article on the Use of the Capsulsc Renales, are noticed in the Medicinisch-Chi- 
rurgische Zeitung, for May last. 

Dr. Green's Cases of Fractured Liver are noticed in the Bibliothek for L<e- 
ger. No. 3, 1830. 

Authors of new medical books, desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editor 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused by 
the circuitous routes through which they are received. 

Papers intended for publication, should be sent, free of expense, as early after 
the appearance of the Journal as possible, in order to be in time for the ensuing 
number. Such communications should be addressed to *' Carey & Lea, Phila- 
delphia, for the Editor of the American Journal of theMedical Sciences," or may 
be deposited with Professor J. C. Warren, M. D. Boston — C. Drake, M. D. 
New York, or Professor S. H. Dickson, M. D. Charleston, S. C. 

All letters on the business of the Journal to be addressed exclusively to the 
publishers. 



CONTENTS 



ORIGINAL COMMUNICATIONS, 

ESSAYS. 
Art. Fag^, 

I. Remarks on the Autumnal Remitting- Fever, as it appeared in Dallas 
County, Alabama, in the months of September and October, 1831. By 
J. Wig-gins Heustis, M. D. ------- - 279 

n. Account of the Scarlatina which prevailed in Deeriield, Massachusetts, 
in the years 1830 a^d 1831. By Stephen W. Williams, M. D. late Profes- 
sor of Medical Jurisprudence in the Berkshire Medical Institution - 293 

III. Case of Diseased Spine. By Thomas Sewall, M. D. Professor of Ana- 
tomy and Physiolog-y in the Columbian Colleg'e, D. C. [With a plate.] 300 

IV. Reports of Cases of Injuries of the Head, treated at the Pennsylvania 
Hospital. By G. W. Norris, M. D. one of the resident Physicians - 304 

v. Observations on the Remedial Powers of the Cimicifug-a Racemosa in 
the Treatment of Chorea. By Jesse Young", M. D. of Chester County, 
Penn. 310 

VI. Observations on those Pathological States of the System g-enerally de- 
signated Asthenia, Adynamia, Debility, Weakness, &c. By E. Geddings, 
M. D. Professor of Anatomy in the University of Maryland; one of the 
Surgeons to the Baltimore Infirmary, &,c. , - - ^ - 315 

VII. Observations on the Bilious Remittent Fever, which prevailed in 
Burke County, Georgia, during the Summer and Fall of 1831. By A. C. 
Baldwin, M. D. 34J^ 

MEDICAL EDUCATION AND INSTITUTIONS. 

VIII. An Account of the Origin, Progress, and Present State of the Medi- 
cal School of Paris -.----.,»- 351. 

REVIEWS. 

IX. Precis d'Anatomie Pathologique. Par G. Andral, Professeur, &c. 

A Treatise on Pathological Anatomy. By G. Andral, Professor of the Fa- 
culty of Medicine of Paris, &c. Translated from the French by Richard 
Townsend, A. B., M. D. &.c. and Wilham West, A. M., M. D. &c. Two 
volumes, 8vo. pp. 698 and 808. Dublin, 1829 - - - - a89 

X. The Library of Practical Medicine; published by order of the Massa- 
chusetts Medical Society for the use of its Fellows. Vol, I. Containing a 
Treatise on Fever. By Southwood Smith, M. D.; and Clinical Illustra- 
tions of Fever. By A. Tweedie, M. D. Simpson & Clapp. Boston, 1831 419 

XI. Report on the Epidemic Cholera Morbus, as it visited the Territories 



276 CONTENTS. 

Page. 

subject to the Presidency of Bengal, in the years 1817, 1818, and 1819. 
Drawn up by order of the Government, under the superintendance of the 
Medical Board. By James Jameson, Assistant Surgeon and Secretary to 
the Board. Calcutta, 1820, pp. Ixxxiv and 324, 8vo. With a map. 

Sketches of the most Prevalent Diseases of India; comprising a Treatise on 
the Epidemic Cholera of the East, Sec. &c. By James Annesley, Esq. 
Madras Medical Establishment, &c. &c. &c. Second edition, London, 
1831. With a map. 

Treatise on Cholera Asphyxia or Epidemic Cholera, as it appeared in Asia, 
and more recently in Europe. By George Hamilton Bell, Fellow of the 
Royal College of Surgeons, Edinburgh, late Residency Surgeon, Tan- 
jore. Edinburgh and London, 1831, pp. 150, 8vo. With a map. 

A History of the Contagious Cholera, with Facts explanatory of its Origin 
and Laws, and a Rational Method of Cure. By James Kennedy, Member 
of the Royal College of Surgeons. London, pp. 291. With two maps. 

Quelques Reflexions sur le Cholera Morbus. Par le Dr. Jaehnichen, Mem- 
bre du Conseil temporaire de Medecine de Moscou. Moscow, 1831. 

History of the Epidemic Spasmodic Cholera of Russia; including a Copious 
Account of the Disease which has prevailed in India, and which has tra- 
velled under that name from Asia into Europe. Illustrated by numerous 
Official and other Documents, explanatory of the Nature, Treatment, 
and Prevention of the Malady. By Bisset Hawkins, M. D. &c. London^ 
1831, pp. 306. With a map 441 

BIBLIOGRAPHICAL NOTICES. 

XII. A Short Tract on the Formation of Tumours, and the Peculiarities 
that are met with in the Structure of those that have become Cancerous; 
with their Mode of Treatment. By Sir Everard Home, Bart. &c. &c. 8vo. 

pp. 98, with several plates. Sept. 1830 488 

Xm. A Treatise on Physiology applied to Pathology. By F. J. V. Brous- 
sals, M. D. Sec. &c. &c. Translated from the French, by John Bell, M. 
D. Sec. &c. and Rene La Roche, M. D. &c. &c. Third American edi- 
tion, with notes and a copious appendix, 8vo. pp. 666. Philadelphia, 

Carey & Lea ----- 494 

XIV. Handbuch der Anatomic des Menschlichen Korpers. Von Dr. Anton 
Romer, Sr. k. k. apostol. Majestat Rathe, Stabsfeldarzte, ordentlichem, 
bffenthchem. Professor der Anatomie an der k. k. Medicinisch-chirurg- 
ischen Josephs- Akademie, &c. 8cc. &c. Erster Band. pp. 308. Wien, 
1831. 
Manual of Human Anatomy. By Dr. Anton Romer, Professor of Anatomy 
in the Imperial Joseph's Medico-chirurgical Academy, &c. &c. Vol. I. 
Vienna, 1831 - - , , 497 



CONTENTS. 



277 



QUARTERLY PERISCOPE. 
FOREIGN INTELLIGENCE. 



Akatomt. 



Page. 
1. Case of Hermaphrodism. By 
M. Rudolphi ... 499 



Page. 

2. Case of Monstrosity. By M. 
Geoffroy St. Hilaire - . 499 



Phtsiolggt. 



3. Case of Extraordinary Absti- 
nence - - - . 499 

4. Influence of the Mind over Dis- 
ease. By Dr. Mathy - - 500 



5. On the Sounds of the Heart. 
By M. Despine - - . 500 



Pathologt. 



6. On Inflammation of the Medul- 
lary Tissue of the long- Bones. 

By M. Reynaud - - 500 

7. Case of Tetanus from Inflam- 
mation of Spinal Cord. By M. 
Combette .... 503 

8. Small-Pox. By M. Louis - 504 

9. Cysts in the Heart. By M. 
Flandin .... ib. 



10. Pustules in the Intestines 
caused by the Internal Admi- 
nistration of Tartar Emetic. By 
M. Guerard ... 

11. Coexistence of Mumps with 
Leucorrhoeal Discharg-e. By 
Mr. John Dunn 

12. Partial Aneurism of the 
Heart? By M. Vidal - 



504 



Materia Medica and Phakmact. 



13. Properties and Therapeutic 
Uses of Potatoes. ByM.Nauche 504 

14. On the Therapeutic Proper- 



ties of the Ava Root. By Mr. 
Collie - - - - 505 

15. Experiments on Conium Ma- 
culatum. By R. Battley - 506 



Practice of Medicine. 



16. Case of Arthritis and Sciatica 
treated by Acupuncturation 
with Complete success. By Mr. 
John Hamilton ... 508 

17. Neuralgia successfully treated 
with the Cyanuret of Potassium. 

By Dr. Lombard - - 511 

18. New Mode of Administering 
Calomel for the Cure of Syphi- 
lis. By M. Biett - - 512 

19. Sulphate of Quinine as a Re- 
medy for Taenia. By Dr. 
Kunzsch ... - ib. 



512 



5i: 



20. Case of Epilepsy relieved by 
Nitrate of Silver. By Dr. Dar- 
wall 

21. Excoriations of the Mammae. 
By Dr. Feist 

22. Case of Pulmonary Affection 
relieved by Inhalation of Chlo- 
rine. By Mr. Richard Hardy 

23. On the Connexion between 
Abdominal Diseases and Chro- 
nic Meningitis. By Dr. Hastings 514 



lb. 



OrnTHALMOLOOT. 



24. Increased sensibility of the 
Retina. By R. Middlemore, Esq. 516 

25. Chloride of Lime in Purulent 
Ophthalmia. By Dr. Herzberg 518 



I 26. Inflammation ofthe Eyes from 
Crusta Lactea. By M. Stein- 
heim 



519 



278 



CONTENTS. 



SuBGEnr. 



Page. 

27. Case of Inguinal Aneurism in 
which the External Iliac Artery 
was tied. By Mr. Brodie - 520 

28. Extirpation of an Osteo-Sar- 
comatous Jaw. By Professor 
Regnoli - - - - 521 

29. Aneurism of the Right Axil- 
lary Artery cured by tying the 



Pagk, 
Subclavian Artery. By W. 
Bland, Esq. • - - 523 

30. Nervous Tubercle. By Mr. 
Syrae - - - - 524 

31. Luxation of the Humerus of 
Forty-eight Days duration Suc- 
cessfully Reduced. By M. 
Breschet . - - - ib. 



Medical JunispRTrDENCE. 



32. On the Detection and Identi- 
fication of Arsenic in Complex 
Organic Mixtures. By Dr. Ro- 
bert Venables ... 



Ani- 



525 



33. Is the Meat of Diseased 
mals unwholesome? - - 529 

34. On Poisoning with Acetic 
Acid. By M. Orfila - - 530 



35. Births in Prussia 



Medical Statistics. 

531 I 36. Statistics of Calculous Dis- 
''■ ] eases. By Dr. Yelloly - 531 



Chemistry. 



37. Preparation of Hydriodate of 
Potash. By Dr. William Gre- 
gory ----- 532 



). Silex in Urinary Calculi. By 
Dr. Yelloly - - - 532 



Miscellaneous. 



39. Violent Cholera at Clapham 523 

40. On the Supposed Importation 
of the Cholera into Russia, by a 

. Russian corps recently arrived 
from Turkey. By M. Londe 535 



41. Atmospherical Changes dur- 
ing the Prevalence of the late 
Influenza in England. By J. A. 
Hingeston, Esq. - - 536 



AMERICAN INTELLIGENCE. 



Case of Chief Justice Marshall 

Structure of the Lungs. By Pro- 
fessor Horner, of the University 
of Pennsylvania 

Sphincter Vesicse. By Professor 
Horner, of the University of 
Pennsylvania 

On the Wax Myrtle. By William 
M. Fahnestock, M. D. 

Contributions to the Pathology of 
Traumatic Tetanus. By William 
W. Valk, M. D. - - 



537 



538 



ib. 



ib. 



541 



On the State of the Dew Point 
as Connected with the Pre- 
vailing Influenza. By James P. 
Espy, of Philadelphia. (Com- 
municated in a letter to Dr. 
Hays) - . . - 

Influenza .... 

Cerebral Spinal Axis of Man - 

Index - - - 

Advehtisements - - - 



541 

542 
544 
545 
549 



Tacje 203 











i4- 

THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



Art. I. Remarks on the Autumnal Remitting Fever^ as it appeared 
in Dallas County^ Alabama^ in the months of September and Oc- 
tober^ 1831. Bj J. Wiggins Heustis, M. D. 

After a winter of unusual severity, spring at length returned, 
though tardy. The earth had been greatly chilled by the severity of 
the frost, so that it was late in May before the commencement of 
warm weather. Parts of June and August, and the whole of July, 
were unusually dry, and vegetation of every description was much 
injured by the severity of the drought, which was more sensibly felt 
in consequence of the plentiful supply of rain that had previously 
fallen, which, filling to exuberance with sap the growing plants, 
caused a proportionable degree of suffering, from a sudden suspen- 
sion of their necessary aliment 

About the first of August the sun presented an unusual appear- 
ance, which was observed throughout the United States, and perhaps 
elsewhere. Soon after rising, and just before sitting, its aspect 
was singularly striking, being clear and pale, of a bluish-green 
complexion, much like a well-burnished pewter dish. Its beams, 
even at noonday, were peculiarly faint and pale; and, as cast upon 
the floor through a door or window, of a sickly blue and greenish 
hue. This phenomenon appears to have been owing to an unusual 
accumulation of vapour in the atmosphere. The most satisfactory 
explanation of this circumstance is contained in a communication 
from Benjamin Hallowell, of Alexandria, Va. dated August 
20th, 1831, and published in the National Intelligencer of the 
24th. As the phenomenon is of a rare and interesting character, 
and as being perhaps in some essential degree connected with 
the peculiarity of the season, and the salubrity and insalubrity of the 

No. XVIlI.—Feb. 1832. 25 



280 Heustis on Autumnal Remitting Fever. 

atmosphere, I take the liberty of transcribing the explanation in the 
language of Mr. Hallowell himself, which is as follows: — 

" To understand the phenomena alluded to, it will be necessary to make a 
few preliminary observations. During- the great total eclipse of the sun that 
had recently taken place, the moon had just passed its perigee, or that point 
of its orbit nearest the earth, and consequently the combined action of the sun 
and moon upon the atmosphere produced a great tide in the equatorial regions, 
and diminished the pressure of the air upon the whole surface of the earth.* 
This diminution of pressure upon the surface of the water would occasion a 
great increase of evaporation, particularly when united with the high tempera- 
ture that accompanied it. For it is an established fact, that the amount of eva- 
poration from an insulated surface of water depends upon the elevation of tem- 
perature and diminution of pressure. A vast quantity of vapour thus raised 
was very observable on the evening of the twelfth instant, at a considerable 
elevation in the western part of the heavens, and continued to reflect a very 
red light for a long time after the sun had set. The appearance of the heavens 
on the morning of the thirteenth I did not observe, but about mid-day, the sun 
shining through this body of vapour had a silvery appearance, similar to that 
which it wears when shining through a vanishing fog; and I observed it to give 
an unusually ghastly appearance to the countenances of persons. Between 
three and four o'clock, the position of the sun with respect to this body of va- 
pour becoming changed, it assumed a greenish-blue appearance, precisely 
similar to that produced by the following experiment, and which, in my opi- 
nion, was dependent upon the same cause. Let a screen, upon which the spec- 
trum produced by the separation of the solar beam into its primitive colours by 
a glass prism is thrown, be perforated so as to let all except the red ray fall 
upon a double convex lens, and be converged to a focus, the result will be a 
representation of the sun of a greenish-blue colour, exactly such as it was ob- 
served to have at the time alluded to. The colour is that resulting from a com- 
bination of all the primitive colours except the red, and is denominated in op- 
tics the opposite colour. * * * The greenish-blue colour of the sun, then, I 
think, depended upon the red rays being reflected by the intervening body of 
vapour, while the other six passed to the eye, and produced the observed ap- 
pearance. This opinion was strengthened by one or two facts observed at the 
time. I passed the sun's rays through a prism, and while the yellow, green, 
blue, indigo, and violet colours appeared with their appropriate brightness, 
the orange was considerably less distinct, and the red made less than the 
orange. Another corroborative fact was, that as the sun descended below the 
body of vapour, which was about fifteen or twenty minutes before its sitting, 
the vapour reflected an intensely red light; the light that passed through it 
was, therefore, separate from the red, and would have produced the opposite, 
or greenish-blue appearance. The spot that was observed is by no means an 

* It is evident, that as the air is partially supported by the combined attrac- 
tion of the sun and moon, its pressure upon the earth must be diminished. 
The greatest eflTect would not be at the immediate time of conjunction, but 
some days after. 



Heustis on Autumnal Remitting Fever. 281 

unusual thing upon the sun's disc. It was visible to the unprotected eye, mere- 
ly in consequence of the diminished brightness of the sun. By aid of a tele- 
scope, a considerable number of spots were visible. In the summer of 1816, a 
spot was visible to the naked eye for eight or ten days in succession." 

To whatever atmospheric phenomena and planetary influence it 
may be ascribed, such was the fact, that from about the twelfth of 
August to the third of September there fell an unprecedented quan- 
tity of rain. During almost the whole of this time the heavens were 
overcast with low-hung, lowering, and billowy clouds, that daily pre- 
cipitated immense and overwhelming showers. Nature appeared to 
have undergone a complete revolution — a singularity and change un- 
known to the oldest inhabitants. Notwithstanding the heat of the 
weather, the rapidity of the evaporation, and the vast expenditure of 
moisture in the support and growth of vegetation, such was the sur- 
plus of water that the rivers rose and overflowed their banks, inun- 
dating the low grounds, and doing considerable injury to the crops: 
this was more especially the ease in Georgia and the Carolinas, 
where great damage was sustained from the destruction of bridges 
and other property. The town of Augusta, in Georgia, was partially 
inundated, and was subsequently visited with an alarming degree 
and prevalence of sickness. The town of Tuscaloosa, in this state, 
also suffered greatly from a visitation of the autumnal endemic. 
Many towns, however, near the rivers, escaped almost entirely^ of 
which, Cahaba was one^ whilst places more remotely situated from 
the water-courses were subject to disease. This difference was owing 
to local peculiarities; for wherever the rain water formed ponds, and 
became stagnant, or met with a rich and fermenting alluvion, febrile 
miasmata were rapidly evolved, and diffusing their poison through 
the ambient atmosphere, became the cause of disease to such as were 
constantly exposed to them. I say constantly, for a transient expo- 
sure to, and continuance in those infected places, was not sufficient 
to originate the disease. And, indeed, very few persons visiting 
them, and remaining all night, v/ere subsequently affected with fe- 
vers; and but a small proportion of the residents themselves became 
the subjects of disease. 

The miasmata, or materies morbi, inhaled with the atmospheric 
air, and received into the system through the medium of respiration, 
doubtless existed in all who v/ere exposed to it as the predisposing 
cause of fever; but, inmost cases, required the additional aid of some 
debilitating agent to excite it into action, or to render the system 
susceptible to its morbid influence. As long as the various functions 
were performed with regularity, the resources of nature were sufli- 



I^L 



282 Heustis on •Autumnal Remitting Fever. 

cient for all the purposes of healthy but when the regularity of cus- 
tom and habit were infringed upon and deranged by any error in the 
non naturals, or when the constitution was peculiarly susceptible, 
disease was liable to ensue. 

The fever was mostly of the double tertian character, with pa- 
roxysms often protracted, and running into each other without any 
distinct intermission. In other instances, the single tertian type 
prevailed, but of greater severity than the ordinary fever and ague. 
In most cases the sensation of chilliness was slight, and after the first 
paroxysm almost imperceptible. In some, however, the disease was 
ushered in with a severe ague. In the majority of cases the patients 
complained of great pain in the head and back. The pulse was rare- 
ly full and strong, often hard and frequent, and in many cases small, 
weak, and easily compressible; and in persons advanced in life, in- 
termitting, more especially under the operation of evacuants. The 
pain of the head was confined more especially to the forehead, where 
it was often distressing; becoming more aggravated during the exa- 
cerbation of the fever. But notwithstanding the severity of the pains 
in the head and back, the cases in general did not admit of the free 
and liberal extraction of blood. 

The fever this season was of the congestive character, with a great 
disposition to an unequal distribution of febrile action and develop- 
ment. In many cases the head, and particularly the extremities, 
would be cold, while the trunk was hot; whilst at the same time 
there was considerable palpitation of heart, with a pulse small, weak, 
and frequent. In such cases I have known dangerous, and even fatal 
mistakes committed. This weakness of pulse and coldness of the ex- 
tremities having been looked upon as circumstances of febrile remis- 
sion, quinine has been exhibited and persevered in; but so far from 
putting a stop to the progress, or mitigating the disease, the symp- 
toms have become more and more aggravated; the breathing short, 
anxious, and laborious, and interrupted with frequent sighing; the 
pulse, instead of becoming stronger, was rendered still more weak 
and frequent; the sighing and restlessness more urgent; and life was 
finally extinguished from over-stimulation. 

Sickness, restlessness, and feelings of geileral distress were often 
the only, or the principal symptoms by which an accession or recur- 
rence of fever could be ascertained. In other cases a weak and hur- 
ried pulse would be accompanied with an evolution of general increas- 
ed temperature, with heat and dryness in the palms of the hands and 
soles of the feet, and an aggravation of pain in the head and back. 

Sometimes after a transient state of febrile excitation, collapse 



Heustis on JiutuTnnal Remitting Fever, 28 3 

took place at an early stage of the disease, with little impairment of 
the general powers of the system; this was more especially the case 
where depletion had been too freely practised. It is necessary to 
make a distinction between this state of prostration and that which 
takes place at a more advanced period. The first is generally reme- 
diable, the second is not: in the former the prostration and collapse 
are for the most part confined to the vascular system, while such is 
the strength of the muscles of locomotion, that the patient is able to 
rise and sit up, and even to walk about. This disparity of strength 
and power between the two sets of organs also sometimes exists in 
the collapse which takes place towards the termination of the higher 
grades of bilious fever; and the more malignant the disease, the 
sooner is this state liable to ensue. This appears to admit of an easy 
explanation, on the presumption, that as the fluids of the body are 
primarilycontaminated, the strength and vitality of the heart and blood- 
vessels are sooner overpowered and subdued by the deadly poison that 
has been received into them. I have at this time, (Nov. 3d, 1831,) un- 
der my care a gentleman and his daughter, exemplifying this diversity 
of febrile action: in the man the heat and febrile development are ge- 
neral: in the child there is a great proneness to coldness of the extre- 
mities, with a weak, faultering, and almost imperceptible pulse. 
For the purpose of opening the bowels of the latter, I prescribed a 
moderate dose of calomel. After this had operated she was much re- 
lieved. * * Since writing the above the child has died. I had direct- 
ed quinine to be given to her through the day, as she appeared to 
be quite free from fever, in order to resist the tendency to prostra- 
tion. Under this treatment she improved. But a relative of the child, 
on the evening of the 3d, apprehending that the fever had returned, 
discontinued the quinine and administered a dose of castor oil. This 
I learnt on my arrival late the same evening. I did not think that 
her situation authorized its employment. The ensuing day, Nov. 4th, 
she became sick at the stomach, with a disposition to vomit. The 
relative of the child above referred to, endeavoured to encourage this 
by exhibiting a solution of tartar emetic, in broken doses; it failed, 
however, to have the desired effect. No vomiting was produced by 
it, but a cold clammy sweat broke out and exuded profusely from every 
pore. She became cold as marble, complaining at the same time of great 
heat. Arriving late the same evening I found her extremely restless, 
without pulse, clay-like, and dying, another victim to the administra- 
tion of tartar emetic. So many instances have I known of like effects from 
the use of this dangerous article, that it is now several years since I have 
employed it as an emetic. The case above-mentioned, however, was 

2.5* 



284 Heustis on ^Autumnal Remitting Fever. 

one probably of great malignancy; for previously to the administra- 
tion of the tartar emetic she had vomited matter of a black and sooty 
appearance, and the whole vital system appeared to be greatly oppress- 
ed and overpowered. Besides, the dangerous illness of, and the absorb- 
ing interest for the father, caused the case of the child to be overlook- 
ed and disregarded by the family, considering it nothing more than 
a slight indisposition to which she was subject, until several days had 
elapsed, when she was found in the situation before described. The 
mother of the child, a woman of plain good sense, sententiously re- 
marked to me afterwards, "I have done with pukes." 

It generally happens that our autumnal fever ceases as an epide- 
mic about the 10th of October; yet the sporadic cases that occur 
subsequent to that time are of a more obstinate and malignant cha- 
racter. 

Early in the season the discharges from the bowels were mostly of 
a light clay-coloured complexion, with very little black, green, or 
bilious discolouration, so generally remarkable in our autumnal en- 
demics. In the few sporadic cases, however, that occurred after the 
commencement of cool weather, the stools were highly coloured, of 
a dark green, olive, and almost black; becoming in the progress of 
the complaint, of a lighter hue, between an olive and a brown, and 
of a gelatinous, sleek, and oily appearance; but in no case peculiarly 
offensive. In one patient the stools were thin, watery, and of a san- 
guinolent, purplish hue, proceeding probably from a rupture of some 
small blood-vessels of the rectum or colon, occasioned by overaction 
and morbid stimulation of the bowels, an appearance I have several 
times observed. It is not, however, generally a dangerous prognos- 
tic, and may be removed by anodyne injections. 

With the exception of the little girl alluded to before, only two 
persons have died within the sphere of my practice this season, and 
those were in a moribund state when I was called in, and expired in 
a few hours from the time I saw them. Both had been sick several 
days. One was an aged lady. The other a young married woman; the 
cold sweat of death was on her when I arrived at her residence; the 
face was cold and livid, the pulse tremulous and weak, and the 
whole system rapidly sinking; the taper of vitality was fast decaying, 
nor could it be revived by all the resources and remedies that were 
employed. 

To these observations I beg leave to subjoin a few practical re- 
marks. In a great proportion of cases the physician was never con- 
sulted; in others, medical advice was obtained, and the friends or fa- 
mily administered their own medicine; in others again the physician 



Heustis on Autumnal Remitting Fever. 285 

was applied to for medicine and advice, and in a few of the more 
desperate only was his attendance required. 

It was seldom that I was called in at an early stage of the disease. 
Domestic skill was generally resorted to in the first instance, which 
failing, the physician was applied to as a dernier resort. Emetics or 
cathartics, or probably both, had already been employed, and proba- 
bly to too great an extent; so that the stomach and bowels being al- 
ready in a state of commotion, and the patient frequently harassed 
with watery discharges by vomiting and stool, it became necessary to 
allay these inordinate actions. 

As in former years, so in this, much injury was often done by the 
exhibition of tartar emetic; fortunately, however, the remedy is now, 
I believe, generally laid aside; though a few physicians still continu- 
ing to use it, cause it to keep up a limited credit and employment. 
The time, however, I trust and believe is not far distant, when this 
poisonous and dangerous article, as an emetic, will be discarded 
from among the medicines employed in the treatment of the autum- 
nal fevers of our climate. When given even in doses of a few grains, 
I have known it to produce sudden, dangerous, and fatal collapses, 
and a persisting and uncontrollable catharsis, in consequence of the 
erythema and irritation excited in the mucous surface of the sto- 
mach and intestines. Given in minute quantities it is still valuable 
as a diaphoretic, the only manner and purpose in and for which I 
exhibit it. 

I administered but one emetic this season, and that rather in com- 
pliance with the wishes and prejudices of the patient, than from my 
own views of its utility. It was a case, however, of chill and fever, 
of rather a mild and intermitting type, and little danger was there- 
fore apprehended from the operation of a mild emetic. To use 
his own language, as he wished something to turn it down after it 
had vomited him sufficiently, I added to the ipecacuanha a sufficient 
quantity of jalap. The patient not being satisfied with the first exhi- 
bition, I repeated the dose, which, aided by copious draughts of warm 
water, acted effectually both as an emetic and cathartic. He re- 
marked that he had taken ipecacuanha before, but never any that had 
operated so roughly. The fever subsiding with the operation of the 
medicine, left him in a situation to take quinine; about thirty grains 
of which restored him to his usual health. I had previously remark- 
ed, while in Florida, in 1818, the efficacy of emetico-cathartics in 
breaking up morbid associations, and putting a sudden check to fever 
if exhibited in an early stage of the disease. The articles I made 
use of were ipecacuanha, calomel, and jalap. In a great majority of 



286 Heustis on Autumnal Remitting Fever. 

cases the fever was in this manner suddenly cut short by a single 
dose of medicine. For the same purpose the owners of slaves in this 
country are in the habit of giving to their negroes at the first an- 
nouncement of disease, salts and tartar emetic combined. But it is 
seldom in country practice that the physician sees the patient suffi- 
ciently early to admit of .this mode of treatment with any degree of 
safety. In a preceding number of this Journal, I have pointed out 
the danger of exhibiting tartar emetic, nor have I since had any rea- 
son to alter my opinion. 

Notwithstanding the severity of the pains in the head and back, 
the cases in general did not admit of the free and liberal extraction 
of blood, or it was seldom that the physician saw the patient at a 
proper season to avail himself of its employment; and for the most 
part, the loss of four or five ounces was sufficient to produce a reduc- 
tion and softening of the pulse. If the febrile action was considerable, 
with much head-ache, as there generally was, and a hot skin, bleed- 
ing was highly useful. But the quantity required at any one opera- 
tion, was small, seldom exceeding eight or ten ounces; if the ex- 
traction went much beyond this, there was danger of sinking and 
alarming prostration. In this, there was a peculiarity, different from 
what existed in the fevers of former years, when I have known the 
pulse to remain firm after the loss of twenty or thirty ounces of blood. 
In one instance, the too free operation of bleeding had nearly proved 
fatal. This took place at the commencement of the sickly season, 
before the character of the epidemic was well understood. The case 
was that of a young, stout, athletic negro man, full of life and blood, 
but in whom the arterial action was not in proportion to the habit of 
body, and the other symptoms of the fever. The pulse, instead of 
being full and strong, or hard, vibrating, and elastic, was, on the 
contrary, rather small and contracted, indicating a congestive state 
of fever. I opened a vein, though on the third day of the disease, and 
without much alteration of symptoms, permitted the blood to flow 
until nearly twenty ounces had been extracted. Finding that no 
disposition to syncope or perspiration was produced, and that the 
trunk still continued preternaturally warm, I gave him the cold bath, 
seating him on a chair, and affusing with a small pitcher, about four 
gallons of cold well water on the naked body. He was now cool, 
and being conveyed to bed, expressed himself much relieved. I now 
gave him about twenty grains of calomel, with directions to exhibit 
a dose of castor oil, should not the calomel operate in the course of 
three or four hours; I then left him to visit other patients: returning 
in about three hours, I was startled to find him labouring under a 



Heustis on Autumnal Remitting Fever. 287 

state of extreme arterial prostration » His system had not reacted 
from the effects of the cold bath; and the castor oil, which had been 
exhibited too soon, together with the calomel, had already produced 
profuse and repeated dejections from the bowels. The extremities 
were cold, the countenance inanimate, the voice and consciousness 
nearly extinct, and the pulse thread-like, evanescent, and only per- 
ceptible to the most accurate and delicate touch. Without delay I 
applied blistering plasters to the extremities, made frictions with hot 
brandy, gave him an anodyne to check the operation on the bowels, 
and stimulated him with quinine, exhibited every hour; sinapisms 
and poke root poultices were subsequently applied to the soles of the 
feet and to the palms of the hands. This case remained critical and 
doubtful for several days; re'action however ultimately took place, with 
an accession of fever, which was combated by febrifuges and ape- 
rients, and the man recovered . The error in this case consisted in 
making too full and liberal extraction of blood, without, as yet, being 
sufficiently acquainted with the character of the epidemic; the paying 
too little attention to the state of the pulse, which, though the patient 
was of a strong and athletic habit, did not possess sufficient develop- 
ment and force to authorize the free use of the lancet. Yet, here 
again I was imposed upon; for, as the patient was bled sitting up, 
and as no disposition to syncope took place, with but little change of 
the pulse or other symptoms, the extraction was considered within 
the bounds of prudence. A second error was, in making too free 
use of the cold bath; and the third in following up these two Hercu- 
lean remedies, by exhibiting a twenty grain dose of calomel; the latter,, 
however, might not have been injurious, had it not, contrary to my 
directions, been succeeded too soon by the exhibition of a large dose 
of castor oil. 

The uncertainty, and the diversified effects from the operation of 
blood-letting, show the impropriety of trusting this efficient remedy 
to any other than the hands and discretion of the attending physician. 
Much danger is to be apprehended from the mechanical operator, 
who, ignorant of the animal economy, and of the phenomena of health 
and disease, can have no proper conception of the circumstances, 
necessities, and changing symptoms of the patient, which govern and 
regulate the use of this important operation. Nor is it possible for 
the physician to decide, from the symptoms merely, the effect that 
may be produced, or the degree to which the extraction of blood 
should be performed. In the use of the lancet, I have always found 
it necessary to watch the patient with much care and attention, to 
ascertain the extent which may be required. Suppose, for instance, 



^88 Heustis on Jiuiumnal Remitting Fever. 

that from the habit and constitution of the patient, and the height of 
the febrile excitement, the physician should prescribe the loss of 
twenty ounces of blood, when he would safely bear but ten, the con- 
sequence might be fatal. Therefore, while the blood is flowing, the 
finger, from time to time, should be applied to the artery, to ascertain 
when a change takes place in the pulse. The feelings of the patient, 
the countenance, and the state of the skin should also be watched with 
great circumspection. In the disease of this season, so characterized 
by unequal and irregular excitement, I sometimes found the best 
effects from immersing the lower extremities in warm water, and 
taking a gill or two of blood from the foot whilst thus immersed. 
From a state of extreme restlessness and distress, I have known the 
patient, in this manner, in a few minutes become composed and very 
materially relieved. These small bleedings were repeated as often 
as the exacerbations of fever, with pain in the head and back, seemed 
to require them. 

In the fever under consideration, the bowels were, for the most 
part, easily operated on. As a cathartic, when one was required, I 
gave a preference to calomel and castor oil. To children, and to 
persons of much gastric irritability, I prescribed an infusion of senna, 
either alone, or in combination with manna. On many occasions, 
however, I was under the necessity of exhibiting anodynes to mo- 
derate and suspend the undue action, and the too frequent discharges 
from the bowels. A neglect of proper attention to this circumstance 
was sometimes productive of dangerous or f^tal consequences. I was 
informed of several cases, in which, from the description, I have no 
doubt death was occasioned by hypercatharsis, induced by the inju- 
dicious exhibition of purgative medicines. In most instances, I found 
an advantage in the use of enemata, in preference to the exhibition of 
more active cathartics by the mouth. When the patient became rest- 
less, during the paroxysm of a fever, at the same time that the eva- 
cuations from the bowels had been for several hours suspended, an 
enema, composed of a little warm water, or gruel, salt, and molasses, 
was extremely serviceable in allaying the disquietude, and affording 
composure to the system^ and if repeated a few times, was generally 
sufficient to empty the bowels effectually. Indeed, after the first 
dose, I seldom found it necessary to give an active cathartic of any 
kind during the whole of the subsequent treatment of the disease; 
and at most a dose or two of Seidlitz powders, aided by the occasional 
use of cream of tartar, or the compound nitrous powders, to be pre- 
sently mentioned, was all that was necessary, especially if assisted 
by enemata, to keep the bowels sufficiently regular and open. Fre- 



Heustis on %fiutumnal Remitting Fever, 289 

quent, watery, and pale coloured dejections were debilitating and 
injurious; these I always endeavoured to suppress, either by anodynes 
exhibited by the mouth, or more effectually by a tea-spoonful of lau- 
danum given with an injection of a gill or two of warm water or 

gruel. 

As a febrifuge during the paroxysm, whenever there existed too 
great a degree of constipation, I prescribed cream of tartar and spirit 
of nitre; when the bowels were too open I directed lemonade. I found 
however, the most decided benefit from the following: — Sal. nitre, 
gr. 8, pulv. Doveri, gr. 2, calomel, 2 vel. 3, antimon. tartaresat. gr. 
|, Mf. pulv. to be repeated every three hours. This compound 1 
found to operate as a powerful diaphoretic, whilst the small propor- 
tion of opium in the Dover's powders allayed nervous irritation, and 
greatly assisted the other articles. In one instance only did the use 
of these powders produce salivation, and that in a slight degree; the 
other cases yielding before a sufficient quantity of mercury had been 
taken to produce that eflfect. 

Whenever the temperature was high and generally diffused, I 
found, as in former years, the best eJBTect from the cold bath given by 
affusion. In distressing and protracted paroxysms, which had per- 
haps continued thirty-six or forty-eight hours, on arriving and finding 
a general heat and dryness of the whole surface, pain in the head, 
and pulse tense and frequent, I have, without delay, directed the 
affusion of four or five gallons of cold water on the naked body, 
wiping and conveying the patient to bed; I have then sometimes given, 
with signal benefit, an anodyne sudorific mixture, composed of a tea- 
spoonful or two of spirit of nitre, the same quantity of paregoric, of 
twice the ordinary strength of the Dispensatories, and fifteen or 
twenty drops of antimonial wine. A warm fluid perspiration, by the 
use of 4;hese means, soon breaks out, which, being rather encouraged 
by drinking freely of cream of tartar and water, or lemonade, with from 
ten to fifteen drops of antimonial wine every two hours, leaves the 
system cool and free from fever, and in a proper situation for taking 
quinine. When the arterial action is strong and hard, I premise the 
use of the cold bath by the extraction of a few ounces of blood. When 
this circumstance has not been attended to, I have known the cold 
bath administered and repeated with nothing more than temporary 
relief; the fever in a few minutes developing itself with as great in- 
tensity as before. This is more apt to be the case in persons of strong 
constitutions and sanguine habits, from northern and healthy climates. 
If, after the first exhibition of the cold bath, it is found that the heat 
and increased arterial actions soon return, it will be better to have 



290 Heustis on Jiutumnal Remitting Fever, 

recourse to venesection, previously to a repetition of the bath, which 
may then be given, should not the bleeding have had the effect of 
superseding its necessity with every probability of success. 

When the increased temperature was only partial, as was fre- 
quently the case, being confined to the head and trunk, whilst the 
extremities were colder than natural, the general cold bath was not 
admissible; at least I have never employed it under these circum- 
stances. In such cases cloths wet with cold water were beneficially 
applied to the head, chest, and abdomen. For this purpose I made 
use of large towels, or two or three of them together, and folded se- 
veral times, so as to prevent their becoming too soon heated. These 
were renewed every fifteen or twenty minutes, or as often as they 
became warm, until the heat became permanently reduced to the na- 
tural standard, or a perspiration made its appearance. This plan is 
also adviseable in those cases where the general cold bath might be 
objectionable on account of the existing debility of the patient. 
When there was an undue accumulation of heat in the extremities, 
as was not unfrequently the case, great relief and benefit were de- 
rived from sponging or wetting them with cold diluted vinegar, or 
what was preferable, lime juice and water. 

With respect to the exhibition and utility of quinine, in cases of 
well-marked intermitting fever, thfere is no question; but in the bi- 
lious remittent great care and circumspection are required in its em- 
ployment. The physician is here often compelled to witness from 
day to day, the wasting ravages of disease slowly or more rapidly 
undermining the strength and constitution of the patient, without the 
power of arresting its progress. It seldom happens, however, that a 
remission more or less considerable, does not take place, at least 
once in the twenty-four hours; this is known by the reduced hard- 
ness and frequency of the pulse, the cessation of head-ache, and the 
distressing thirst and dryness of the mouth, by a state of compa- 
rative ease and composure, and perhaps by the appearance of a per- 
spiration. This, then, is the critical and important period for exhi- 
biting quinine. A perfect apyrexia is not to be expected; but if, as 
often happens, the quinine produces a perspiration, which it does 
more effectually if aided by the exhibition of spirit of nitre and an- 
timonial wine, with an infusion of serpentaria or sassafras; if in this 
manner general perspiration is produced and kept up, we may be sa- 
tisfied that the exhibition is safe and proper. When the remission is 
short, lasting no longer perhaps than one or two hours, it becomes 
necessary to push the remedy with a bold and vigorous hand. Under 
such circumstances I have often given as many as five grains every 



Heustis on Autumnal Remittent Fever. 291 

hour, either in substance or solution, until the system has become 
well charged, which may be known by a sense of fullness of 
the head, and twitchings and transient sensations of numbness 
in the muscles of voluntary motion^ it then becomes necessary 
to desist for a few hours, when it may be again renewed in 
smaller quantities and at more distant intervals, still keeping the 
system charged for a day or two, until the morbid action shall be 
completely subdued. During its exhibition the perspiration may be 
encouraged by the simultaneous exhibition of the remedies above- 
mentioned. In this way I have often arrested the most dangerous and 
alarming cases of bilious remitting fever, in which fatal consequences 
were apprehended from a repetition of the paroxysm. If, however, 
after one or two exhibitions of this medicine, it should be found that 
the febrile symptoms become aggravated, without the appearance of 
perspiration, we must desist from its employment for the present, 
and watch for a more favourable opportunity. During the exhibition 
of this powerful tonic, the pulse will possess much of the character 
of febrile excitement, being quite frequent or rather quick and jerk- 
ing; but there is at the same time an absence of other febrile symp- 
toms, as thirst, head-ache, a hot and parched skin, &c. This fre- 
quency of pulse under the exhibition of quinine in the bilious remit- 
tent, is partly the remains of fever, and partly the effect of the me- 
dicine employed, and may be considered as the struggle between the 
disease and its remedy. When this shall have been overcome, the 
pulse will resume its firm, slow, full, regular, and healthy beat. At 
the commencement of the disease I have been often foiled in mv at- 
tempt to exhibit quinine, there being present too great a degree of the 
inflammatory diathesis. It becomes necessary, therefore, previouslv 
to correct this state of the system, by the employment of the usual 
remedies, as venesection, should the symptoms justify it, cathartics, 
the cold bath, and other febrifuges. Watching the favourable oppor- 
tunity for a remission, we may then have recourse to the exhibition 
of quinine, with a great probability of success. I would here 
beg leave to remark the frequent complaints and objections made 
against this valuable article of the materia medica by some respecta- 
ble physicians, who contend that its virtues have been greatlv over- 
rated, and that they have never been sensible of any considerable 
advantage from its use. Similar objections were at first raised against 
the parent article, the Peruvian bark itself, and from thesamecause, 
viz. the small and insufficient quantity employed. The cost of this 
medicine, hitherto, has proved a great bar to its extensive and gene- 
ral employment, especially among the more indigent classes of so- 
No. XVIII.— Feb. 1832. 26 



292 Heustis on Autumnal Remittent Fever. 

cietj, and an overstrained economy in the attending physician has 
caused it to be administered in such minute quantities that it might 
well be said to be inert and unavailing. Thus, it is thought by many 
that five grains to the ounce in solution, exhibited in the dose of a 
tea-spoonful every two hours, is amply sufficient. This would make 
but little more than half a grain to a dosej scarcely more than the 
tenth part I have found it expedient and necessary to exhibit, in 
combating such obstinate and formidable diseases as the intermitting 
and remitting fevers frequently are. 

An objection exists with many physicians against the use of opiates 
in fever, and it is doubtless true that their indiscriminate exhibition 
in cases of high arterial action might be productive of injurious effects; 
this, however, affords no argument against their occasional and judi- 
cious exhibition; and I have accordingly found them amongst the 
most valuable remedies that can be employed. It is often desirable to 
procure ease and composure, and a respite from the harassing rest- 
lessness and vigils of disease. For this purpose I often prescribe at 
bed time, provided the fever should not be very considerable, a tea- 
spoonful of paregoric, and the same quantity of spirit of nitre, with 
fifteen or twenty drops of antimonial wine, to be repeated if necessary. 
So far from stimulating the arterial system, and aggravating the fever, 
I have found this prescription one of the most effectual remedies in 
subduing the remains of febrile restlessness and excitement; which it 
appears to accomplish by its anodyne power, and by promoting per- 
spiration, which latter property it possesses in a more eminent de- 
gree than any other medicine or combination of medicines that 1 have 
ever employed. 

The disease this season was not generally marked by any consi- 
derable irritability of the stomach; yet in those few cases where this 
took place, blistering the epigastrium was of great service. Absti- 
nence from all kinds of ingesta, either in the form of drink or nou- 
rishment was also required. For want of attention to this circum- 
stance, I have known the irritability of the stomach and the vomiting 
to continue with great obstinacy. It is in vain, under such circum- 
stances, to endeavour to quell the disturbance by carminatives, aro- 
matic infusions, &c. ; every article of bulk becomes a cause of of- 
fence to the irritable organ, and is sure to be rejected in a few mi- 
nutes from the time of its reception. 

On the morning of the 27th of September I was called to visit A. 
R. a very large and fat elderly gentleman. I found him with a strong 
full pulse, and great irritability of the stomach. The strength and 
fullness of the pulse were rather remarkable, as in persons of much 



Williams on Scarlatina. 293 

obesity I have generally remarked it to be small and weak. The 
person here spoken of, however, was of a strong constitution and in- 
dustrious and active habits, which might account for the difference. 
He had been subject to the remitting fever for several days. When 
I saw him he was labouring under symptoms of cholera. He had 
great thirst, and such was the weakness and irritability of the sto- 
mach that every thing was thrown up almost as soon as it was swallow- 
ed, so that the floor of the room where he lay was inundated with the 
water that he had rejected. I administered a bolus composed of one 
grain of opium, three grains of camphor, and ten grains of calomel; 
at the same time I had his stomach well rubbed with hot brandy and 
laudanum, and then a flannel cloth wet with the same, and applied 
to the epigastrium. I prohibited the use of both liquids and solids, 
except in very small quantities. In pursuance of this treatment the 
stomach soon became composed. In the evening, finding the pulse 
too full and strong, I took away about sixteen ounces of blood. Af- 
ter the lapse of about eighteen hours I allowed him to chew a little 
lean boiled ham, and to swallow the juice, which he did with some 
relish and much benefit; I also permitted him to take from time to 
.time, as his stomach could bear it, two or three tea-spoonsful of 
strong coffee. Quinine was likewise exhibited every two hours in 
such quantity as his situation would admit. Under this treatment he 
rapidly recovered. 

In desperate cases it will often be necessary for the physician, in 
some degree at least, to become also the officiating nurse and con- 
stant attendant, as no other person is competent to adjust the treat- 
ment to the various changing symptoms and necessities of the dis- 
ease. In critical circumstances, where life and death stand almost 
on an equal balance, a slight error is sufficient to turn the scale, to 
the irretrievable destruction of the patient. 

Cahaba, Bahama, Bee. 1831. 



Art. II. Account of the Scarlatina which prevailed ijiBeerfield, Mas- 
sachusetts, in theyears ISSO and 1S51. BySxEPHENW. Williams, 
M. D. late Professor of Medical Jurisprudence in the Berkshire 
Medical Institution, 

In the years 1830 andl 831 scarlet fever prevailed extensively through, 
out New England, and in many towns was very mortal. At intervals 



294 Williams on Scarlatina. 

it has continued to prevail from June 1830 to this time, Nov. 24th, 
1831. The first cases I heard of occurred as early as May, 1830. The 
wdnter of this year was not unusually cold. The month of April was 
remarkably serene and mild; May was cold and uncomfortable; se- 
veral frosts occurred whicli cut down the early planted Indian corn. 
The first cases which occurred in this town were in the latter part of 
June. A child was brought here from Amherst, where the complaint 
prevailed, who had considerable canker about the mouth and throat, 
but who was not supposed to have any thing of the complaint which pre- 
vailed there. In two or three days a child who played with this, 
was attacked with soreness of the throat, canker and fever, which 
were so slight as not to require medical aid. In about a week, the 
mother, who was subject to cynanche tonsillaris, was attacked, and 
sent for me. I found her with high fever, enlarged and inflamed ton- 
sils, and furred tongue. Believing her to have an attack of inflam- 
matory quinsy, I made my prescription for that complaint, and 
did not see her again for five days. When I next visited her, I 
found two of her children, a boy of about fourteen, and a girl 
of about eleven years of age, labouring under the same complaint. 
They had been sick a day or two. They were attacked with cold 
chills, succeeded by great heat, inflamed throats, and swelled tonsils, 
and, at the time I saw them, they complained of great lassitude 
and depression of strength. Upon examining the tonsils of the 
mother and children, I found them covered with white specks of 
ulceration, but still they were so much inflamed that I considered 
them cases of cynanche tonsillaris, having often seen such specks in 
inflammatory quinsy, previous to suppuration. In the case of the 
boy the pulse was very slow, and often preternaturally so. The pulse 
was smaller and quicker in the other two. On visiting them the next 
day I found that the sloughs had extended over the palate and fauces, 
and were more of an ash colour. The difficulty of swallowing was 
very great, so much so that liquids frequently returned through the 
nose. In the children there were copious discharges from the nose, of 
so acrid a character as to excoriate the skin. Restlessness and delirium 
at night. The complaint ran on a fortnight before the fever subsided, 
and it was more than a month before their throats were entirely well; 
indeed, there was great hoarseness and difficulty of swallowing for 
several months. The ulcers nearly destroyed the palate, and made 
great ravages with the tonsils, which were very ragged, and resembled 
honey-comb. I have been rather particular in describing these cases, 
as many of my subsequent ones were similar to them. 
One of the watchers took the complaint from these patients, and 



Williams on Scarlatina. 295 

carried it home with her a distance of half a mile, and communi- 
cated it to her sister. Few other cases occurred for several weeks 
in this town, though, it was very prevalent and fatal in some of the 
neighbouring towns. In several instances the patients were attack- 
ed, and died with it in two days. These cases, however, were attend- 
ed with eruptions, which did not occur in any of the patients I had 
previously seen. 

Ten or a dozen cases of scarlatina occurred in Greenfield, three 
miles north of this town, but none were fatal. Sore throats were un- 
tisually common in this town this season, and many of them termi- 
nated in genuine cynanche tonsillaris. In different parts of the town, 
and at distant intervals, the complaint prevailed, and ran through 
several families. But one patient died of it in 1830, and he was 
sick only thirty-six hours. In this case I was told there was a slight 
eruption, which was the only instance in which it occurred here. I 
did not see this patient until within three hours previous to its 
death, and I am not able to give a detail of the treatment. 

The measles prevailed in scattered cases, but could hardly be 
considered epidemic. A few cases of throat distemper occurred here 
as late as November. 

We had no more cases of the complaint till the latter part of Janu- 
ary, 1831. I find by my meteorological journal, that the weather up 
to the 6th of January had been remarkably warm. A part of the 
time had been very sultry, and the thermometer had been 55° above 
zero, a temperature for the season unprecedented within the recollec- 
tion of the oldest inhabitants. After the middle of the month it was 
very cold, with considerable snow. The thermometer after this was 
eight different times below zero, once 17° below. February was 
also cold, there was a good deal of snow on the ground, and the 
thermometer this month was eight times below zero, and once 17° 
below. I find the following case of scarlatina in my note-book. 
On the 28th of February, 1831, a child of L. P. died of canker- 
rash, aged six. I was called to this child on the afternoon of the 
27th, Sunday. It was taken violently sick on the Thursday be- 
fore with a putrid sore throat, high fever, and scarlet eruptions. The 
usual common applications were used by the family before I saw it. 
I found it with an extremely feeble, rapid pulse, throat and mouth 
filled with very putrid and offensive smelling ulcers, and the skin 
hot and dry, and covered with scarlet miliary eruptions. The dis- 
charges from his mouth and nose were very acrid, and nauseous in 
the extreme, excoriating the skin wherever they touched. I pro- 
nounced the case a hopeless one. I gave it a dose af castor oil, di-. 



296 Williams on Scarlatina, 

rected an antimonial solution, to use the statice limonium both for 
a draught and gargle, and to use gargles of a solution of chloride of 
soda. The next morning before sunrise I was again called to it, but 
before I arrived the child was a corpse. This is the third case of 
canker-rash to this date which has proved fatal in this, town this 
year. Many scattering cases have occurred in various parts of the 
town since last fall. In Conway, and some other of the neigh- 
bouring towns, it has been very prevalent and fatal. The com- 
plaint this year has generally been attended with an eruption, 
sometimes of the miliary kind, and sometimes it has appeared 
in blotches like erysipelas, constituting genuine canker-rash. I 
was deceived in one case, and supposed it to be genuine ery- 
sipelas, as there was but little affection of the throat. Soon other 
members of the family were attacked with scarlatina, which con- 
vinced me that I had made a wrong prognosis. The complaint has, 
however, assumed all appearances, from the mildest to the most ma- 
lignant forms. Frequently there would appear a great crop of erup- 
tions without any affection of the throat, and often considerable sore- 
ness of the throat and stiffness of the muscles of the neck without 
any eruptions. I have generally found that where the eruption made 
its appearance soon after the throat was affected, especially if it was 
of the miliary kind, and appeared iirst in the superior parts of the 
body, and by the third day disappeared at the l^wer extremities, 
that my patients recovered better and quicker than when the erup- 
tion was four or live days in making its appearance. When this lat- 
ter state has been the case I have often considered their situation 
dangerous and alarming, attended with high fever, quick and feeble 
pulse, and delirium; and where the cases have not been fatal they 
have been extremely slow in recovering. 

There were two fatal cases in March, and one in April. The 
complaint arrived at its acme in May. In this month there were five 
deaths — four of them occurred in one day. In one small village, 
(Cheapside,) almost every child was affected with it, and there were 
six or seven deaths in rapid succession there from it. 

From my note-book I find that scarlet fever, sometimes attended 
with canker, and sometimes not, continued to prevail to the 13th of 
June in various parts of the country. The weather from the 29th of 
May to this time has been unusually and intensely hot for the time 
of year. The thermometer was over 90° in the shade the two last 
days of May, and the four first days of June it ranged from 92° to 
96°. Up to this time it is very hot and dry. The month of May was 
very cold and wet, and during this month the canker-rash prevailed 



Williams on Scarlatina. 297 

extensively here. As the weather grew milder the cases were nu- 
merous^ but mild. No death from that or any other complaint oc- 
curred in this town from the 16th of May to the 13th of June. From 
what I can learn, I believe the complaint is, and has been, pretty 
general throughout a considerable portion of the United States. I 
have seei^ an account of its great ravages at Pittsburgh, beyond the 
Alleghanies, and of its prevalence in Burlington, Vermont. 

From the 1st of May to the 1st of October the hooping-cough pre- 
vailed here very extensively and severely. No deaths occurred from 
it. From that time to this, scattering cases of scarlatina occurred — 
and we have now, November 24th, one or two very severe cases. 
Since the commencement of sore throat in this town, we have had 
about two hundred and fifty cases, and sixteen deaths from it. The 
population of Deerfield is a little more than two thousand. The ave- 
rage number of deaths in this town for the last twenty years has been 
about twenty a year. This year, up to this time, there have been 
forty-three deaths — many of them have been from chronic com- 
plaints. 

Treatment. — In the treatment of this disease I have probably used 
nothing new. At its commencement, my cases were unquestionably 
inflammatory quinsy, but they soon terminated in the putrid form of 
the malady. My first cases were treated with cathartics of calomel, 
followed with jalap and crem. tartar, ol. ricini, senna, aniseed, and 
glycyrrh. or with neutral salts. Purgatives have always had a good 
effect at the commencement, and where they have operated well 
have obviated the necessity of local or general blood-letting. In a 
few cases I have prescribed emetics, but have not seen the same be- 
nefit from them as from cathartics. After the operation of the latter 
I have made free use of Dover's powder and calomel, diapho- 
retics generally, and the antiphlogistic regimen; pediluvium and 
sinapisms to the feet, and mustard-seed poultices, blisters, vine- 
gar and water, and volatile liniment applied externally to the throat, 
appeared to lessen local inflammation. Inhalations of the vapour of 
sage tea and vinegar from the nose of a coffee-pot, gargles of gold- 
thread, alum and honey, borax, slippery-elm, and solutions of chlo- 
ride of soda, and decoctions of marsh-rosemary, were beneficially 
applied to the internal fauces and tonsils. The frequent use of dilute 
muriatic acid in water was of great service. It is thus prepared: — 
B. Acid, muriat. gtt. xL; aq. bullient. tfess.; mel. coch. mag. 3. I 
direct the patient to take a large spoonful of it every four hours, and 
gargle the mouth and throat with it frequently. It has a good tonic 



298 Williams on Scarlatina. 

eflfect in the convalescing stage. This medicine is highly extolled by 
several English physicians in this complaint. I have used it with 
much advantage in mercurial sore mouth, and in cases of canker. 
The decoction of statice limonium §ss. to Jfess. of boiling water, a 
table-spoonful at a dose several times a day, was an excellent tonic 
and detergent. 

To correct the fetor of the breath I made a free use of the chloride 
of soda, in the proportion of one table-spoonful to ten of water, for 
a gargle and wash. I also use this medicine extensively in mercu- 
rial sore mouths. In the convalescing stage generous diet was resort- 
ed to, the sulphate of quinine, bark and wine, decoctions of serpen- 
taria, chamomile, carriage exercise, &c. &c. These were general re- 
medies, which were varied, and others substituted according to the 
circumstances of the case. 

My patients were slow in recovering, and for several weeks many 
of them had great difficulty in sv/allowing; liquids returning through 
the nose, and great hoarseness. I ought not to have omitted to men- 
tion the great benefit my patients received from frequent ablution, 
and sponging the body with vinegar and water in a tepid state when 
the skin was hot and dry, and the grateful sensations experienced 
from fomenting the bowels with warm cider brandy. 

Secondary affection of Scarlatina. — In numerous cases there have 
been relapses from scarlatina, and the patients have sunk under drop- 
sical effusions. In most of the secondary affections I have seen, the 
complaint was originally very mild, and perhaps little thought of at 
the time. From slight causes, such as taking a little cold, or over- 
eating, the patient is suddenly taken with universal bloating, and ge- 
neral dropsical effusions. It soon runs on very rapidly, most gene- 
rally to death. I have seen some cases where the affection has been 
general from external and internal hydrocephalus, to general anasarca. 
I have seen the face of one patient so much bloated that he could not 
see. The warm bath, hydragogue cathartics, and diuretics ultimately 
restored him. I have also seen patients die from this complaint in 
the most agonizing distress. In my opinion, in these cases, the pa- 
tients are too much neglected at the commencement of the complaint. 
Thorough evacuations should be resorted to, the avoidance of cold and 
the too free indulgence in eating. Patients in this complaint are very 
much debilitated. Tonics are urgently required. 

Case. — A child of D. A. aged three years, died of the secondary 
affection of scarlatina. About a month before this child was slightly 



Williams on Scarlatina. 299 

afFected with scarlatina, which yielded to common remedies. In about 
ten days he was attacked with a secondary affection of the complaint, 
with slight rigors, high fever, a furred tongue, and bloated bowels. 
These symptoms also yielded, after a while, to purgatives, antiphlogis- 
tics, and tonics. After this he was about the house apparently as well 
as common, for several days, when, inconsequence of over-eating, 
and taking cold, he was severely attacked with high fever, and great 
tumefaction of the bowels, and a brown, furred tongue. A full course 
of purgatives, Dover's powder and calomel combined, seemed to have 
a good effect upon him for several days, and we had expectations of 
his recovery, when suddenly he was attacked with delirium, stupor, 
and great distress. The pupils of his eyes did not appear to be affect- 
ed, and we could not refer his complaint to his brain. The warm 
bath did not appear to alleviate his complaint. He lived several days 
and died distressed. We had no examination by dissection — unfor- 
tunately a prejudice exists against it in this quarter. About the same 
time Mr. A. had two other children, severely afflicted with the secon- 
dary affection of canker-rash which yielded to purgatives, Dover's 
powder and calomel. 

The secondary affection of canker-rash has been common in the 
neighbouring towns, as well as this. It is generally fatal, but not 
invariably so. In one case to which 1 was called in consultation in 
Conway, the child appeared to be universally dropsical. Stupor and 
delirium came on before I saw it, and it was apprehended it would 
immediately die. It was so oedematous that it could not open its 
eyes, and it was white like bleached wax. The warm bath brought on 
reaction before I arrived, and a course of diuretics, purgatives, and 
tonics, finally restored it. In another case, a child, which had a few 
weeks before a slight affection of scarlatina, and which soon apparently 
recovered, in about a fortnight or three weeks after, it was suddenly 
attacked with fever and universal oedema. Extreme distress very 
soon followed, and in three days it died in excruciating agony, and 
the whole body was completely dropsical. 

During the prevalence of this complaint it is frequently asked, can 
nothing be done to prevent it? Various remedies have been used, 
and the following from the Journal Compliment aire, deserves further 
trial. ''. Belladonna, The alleged preventive properties of this article 
in cases of scarlatina induced Dr. Velsen of Cleves to test its efficacy 
in an epidemic which prevailed in that place during the past year. 
The number of those to whom it was administered amounted to 247? 
of both sexes, and of every age, from infants at the breast, to adults 



300 SewoWs Case of Diseased Spine, 

of forty or fifty years. Two grains of the extract were dissolved in 
two ounces of distilled water, to which was added two drachms of 
alcohol, and of this solution five, ten, fifteen, or twenty drops, ac- 
cording to the age of the person, were taken twice a day. The ad- 
ministration of the medicine was continued during the prevalence of 
the epidemic. Of the 247 who were the subjects of the experiment, 
thirteen only contracted the disease, and, in them, according to Dr. 
Velsen, it assumed a milder character than in those who were not 
submitted to this preventive treatment. The following are the con- 
clusions, which he has drawn from his observations. 1. In the great 
majority of cases the belladonna is a preventive against scarlet fever. 
2. Where it fails to produce this effect, the disease is much milder 
than in cases where it has not been given. 3. Administered accord- 
ing to the preceding formula it is productive of no unpleasant con- 
sequences." 

Deerfield, Massachusetts, Nov, 9,Mh, 1831. 



Art. III. Case of Diseased Spine. By Thomas Sewall, M. D. Pro- 
fessor of Anatomy and Physiology in the Columbian College, D. C. 
[With a Plate.] 

i HE following case of spinal aft'ection occurred in the infant son 
of M. E. Hersant, Esq. Consul of France to the United States, a 
child equally remarkable for the premature development of his mind, 
the native stamina of his physical constitution, and the patience with 
which he sustained the extreme sufferings occasioned by a complicated 
train of morbid affections. 

The case did not come under my care until a late period of the dis- 
easej I therefore avail myself of the notes which were made by Madam 
Hersant, and which, she has kindly put into my hands for the bene- 
fit of the public. I am happy to find her journal of the case so full 
and circumstantial as to furnish every fact at all material in giving a 
faithful detail of its history. 

Alexander, the little patient in question, was born in March, 1827, 
:and was a healthy, well-formed child. At the age of two weeks, he 
was severely affected with the thrush, from the consequences of which 
he did not recover for nearly nine months, but upon the approach of 
the fii'st winter, his health returned and he became vigorous and ro- 



^ewalVs Case of Diseased Spine. 301 

bust. In July following he contracted a catarrhal affection, which 
left him with a febrile habit, that continued till late in the autumn; 
and the winter in 1829, found him a great invalid, affected with 
sleepiness, flushing, fever and diarrhoea, and this state continued till 
he was removed to Georgetown in September. Soon after this pe- 
riod, he was seized with occasional turns of vomiting, accompanied 
with a febrile habit, a dry cough and with indigestion. About the 
same time also, it was remarked, that he had acquired the habit of 
raising his body erect, or of throwing it backwards, as if to relieve 
some uneasy sensation; and that he was losing in some degree the 
power and activity of his lower extremities, evinced more especially 
by stumbling as he walked; but late in the autumn, his general ap- 
pearance was improved and he enjoyed comparatively good health for 
two or three months. Early in February, 1830, it was observed for 
the first time, that he manifested uneasiness from the exercise of 
riding in a carriage, and that he could not endure being jolted upon 
the knee, or lifted by the arms. On making an examination to ascer- 
tain whether there was not some strain or dislocation which would 
explain the embarrassment under which he laboured, a small protu- 
berance was discovered over the spine. About this time a great ir- 
ritation of the bladder occurred, accompanied with pain, a frequent 
desire to void urine, and a shuddering when it was discharged; this 
affection increased in its severity to the close of life. About the same 
time the abdomen became tumid and tense, and his sufferings were 
augmented by an attack of the measles, then epidemic in the city, 
which left him with increased debility, cough and fever. 

In March, 1830, I was called upon to give my opinion with respect 
to the nature of the tumour upon the back. Upon examination, I 
found the spinous process of the superior lumbar vertebra slightly 
projecting with a small but obvious curvature of the spine. There 
was tenderness from pressure over the projecting part in its neio-h- 
bourhood, and his motions seemed to be restrained, feeble and tot- 
tering. There was also evident marks of hectic irritation. The 
nature of the case was too obvious to be mistaken and I did not hesi- 
tate to pronounce it an affection of the spine, and one which would 
result in a caries of the vertebrae, and in an extensive deformity, if 
not in death, unless arrested in its progress. 

With respect to the treatment, it would be both tedious and un- 
satisfactory to trace it through the various changes of a case so pro- 
tracted and complicated. I would only observe in reference to the 
spinal disease, that issues were introduced on each side of the affected 
vertebra, in May, 1830, and other topical and general remedies were 



302 Sew&Ws Case of Diseased Spine, 

used. Still the disease advanced with a slow, but steady progress, 
evinced by the increase of fever, loss of appetite and strength, ema- 
ciation, irregular bowels, paroxysms of spas/nodic pain, enlargement 
of the abdomen, and increased curvature of the spine. 

In October, 1830, the little patient was taken to Philadelphia, and 
placed under the care of Dr. John K. Mitchell, a gentleman to 
whom our country is largely indebted- for his extensive investigations, 
and successful method of treating this most formidable disease. 

When the patient was first placed under Dr. Mitchell's care, he 
was suffering under the pressure of a severe hectic, accompanied with 
a tumid abdomen, and diarrhoea, of which the discharges were purulent. 
The pus appeared like that which usually escapes from strumous cavi- 
ties and was supposed to come from an abscess connected with the 
carious vertebra. His appetite was feeble, his respiration hurried and 
irregular, his skin unequally active, his muscular strength almost en- 
tirely gone, and his motions even on the bed to which his debility con- 
fined him, were painful. From a belief that issues are often injurious 
in exciting and keeping up hectic irritation, an opinion, says Dr. 
Mitchell, derived from long observation, they were closed as soon as 
possible. To correct the irritated state of the intestinal action, a 
small blue mass pill was given every evening, and the diet was ren- 
dered as simple as possible. But as no visible improvement follow- 
ed these measures, the little patient was subjected to the use of the 
spine-cart, a remedy which has given signal relief in many cases of 
painful caries of the spine, detailed in the communications of Dr. M 
already before the public. Its application was quite as beneficial as 
anticipated. To use the language of the observant and intelligent 
mother, the swelling of the abdomen subsided, the pains left him, the 
fever abated, and the discharges became in other respects. healthy, al- 
though the purulency was not materially diminished. These changes 
took place in three days after the application of the spine-cart. At 
the end of six weeks, his whole appearance was so much improved as 
to afford a rational hope that the patient might finally attain health 
and a solid spine. When he arrived in Philadelphia, it was neces- 
sary to avoid the slightest jolt; but before his departure for Wash- 
ington, he rode about the streets of Philadelphia, without making any 
complaint. The weather on his journey homewards was both wet and 
stormy, and the necessary exposure brought on a severe catarrh, with 
fever and pain, attended with a loss of appetite, and a diminution of 
flesh and strength. But in the beginning of January, 1851, these 
symptoms abated and he began to recover his appetite and flesh, and 
his bowels became more regular, although the passages were still 



SewalPs Case of Diseased Spine. 303 

charged with pus. From the time he returned from Philadelphia, at 
which period he first became mj patient, the spine-cart was applied 
from three to five hours daily for several weeks, and with evident be- 
nefit; but in the early part of March, he was again affected with cold, 
which brought on a return of all his unfavourable symptoms with in- 
creased violence, and from this time the use of the cart was neces- 
sarily abandoned. The fever returned, accompanied with loss of 
appetite, thirst, fatigue of the lower extremities, great debility and 
sleepiness. The discharge of pus from the bowels became more co- 
pious; the urine was also rendered turbid by its presence, and de- 
posited large quantities of matter when cold. He continued to linger, 
becoming more and more exhausted, till the 12th of July, when he 
died in a state of extreme emaciation. 

Post mortem examination. — Twenty-four hours after death, I made 
a careful examination of the body, in presence of Drs. Washington 
and BoHNEN, and discovered the following appearances: — On laying 
open the abdomen, the liver, spleen, and small intestines alone, were 
found in a healthy condition. The large intestines, in their whole 
extent, were thickened and changed in their organic structure, being 
contracted in some parts, and enlarged in others; with their different 
convolutions, where they came in contact, firmly adhering. The 
whole of the mesentery was thickened, and its glands enlarged to the 
size of grapes. The pancreas was also slightly enlarged and diseased 
in its structure. The left kidney was in a healthy state, but the 
right was enlarged to four times its natural size, with its ureter irre- 
gularly dilated to three-fourths of an inch in diameter, its coats the 
fourth of an inch in thickness, and of a cartilaginous hardness. The 
bladder was diminished in its capacity, and distended with urine and 
pus; its coats were thickened, hard, and elastic, and its mucous sur- 
face studded with small, white tubercles. Behind the peritoneum, 
and in the direction of the right psoas muscle, we found a mass of 
caseous matter, extending from the diseased vertebra to the right 
sacro-iliac junction. The large intestines contained a considerable 
quantity of pus, and a communication was found to exist between the 
diseased vertebra and the arch of the colon, where it crosses the 
spine, by which the matter made its way into the cavity of the intes- 
tines. On removing the intestines, a greater part of the bodies of the 
two superior lumbar vertebra, with the intervening cartilage, were 
found destroyed by the disease and the vacuity created by the caries 
filled with pus. When the matter was washed away, the spine pre- 
sented the appearance exhibited in the accompanying drawing. 

Fig. 1. Shows the spine as straightened to its natural condition. 

No. XVIII.— Feb. 1832. 27 



304 Norris's Cases of Injuries of the Head. 

Fig. 2. Shows the spine as curved in sustaining the superincumbent 
weight of the body. 

Observations. — In reviewing the foregoing case, the following ob- 
servations seem naturally to present themselves to the mind. 

1st. The importance of an early attention to the premonitory diag- 
nostic symptoms of spinal disease, in order that the appropriate re- 
medies may be applied before caries or curvature take place, for it is 
in this early stage only, that medical treatment can be relied on with 
confidence. Whenever, therefore, fever becomes chronic, or is ob- 
stinate, without the detection of an adequate cause, the vertebras 
should be carefully examined by pressure. If no tenderness be dis- 
coverable, we may safely infer the absence of spinal irritation, unless 
the frequent and soothing motions of the spine, the often sought re- 
cumbent posture, and the shuffling gait, determine the application of 
remedies to the spine, even though no tenderness be discovered by 
pressure. 

2d. The immediate and complete relief from pain and other un- 
favourable symptoms by the suspension in a spine-cart, while a re- 
cumbent posture did not abate one morbid symptom, shows that the 
state of entire rest and horizontal position, so strongly insisted on by 
the highest medical authority, is not entitled to unqualified approba- 
tion, and that these two apparently opposite modes of cure demand 
a fuller experimental investigation. 

3d. That although a single case cannot be quoted as adequate tes- 
timony in favour or against any particular mode of treatment, yet 
the unabating progress of the disease while under the application of 
issues, a remedy also established by long usage, and advocated by 
high authority, while an arrest of the disease was aiFected by a re- 
medy less painful, and better adapted to the undisciplined years and 
tender condition of the sufferer, should cause the profession to pause 
and to reconsider well the propriety of their application. 



Art. IV. Reports of Cases of Injuries of the Head^ treated at the 
Pennsylvania Hospital. By G. W. Norris, M. D. one of the 
resident Physicians. 

Case I. compression of the Brain from effusion of blood into the 
Ventricles. — A labouring man was brought into the hospital in Novem- 
ber, 1830, with an injury of the head. The account given by the 



Norris's Cases of Injuries of the Head, 305 

persons who brought him, was, that two hours before a large tackle 
block had fallen from a height of eight or ten feet and struck him 
upon his head — that after a few minutes he got up apparently but little 
injured, and walked from the vessel on board of which the accident 
happened to the wharf, where he sat down and conversed with the 
persons around him — that after about an hour he began to be stupid, 
which state increased gradually till it ended in insensibility. 

When admitted he was completely insensible, with both pupils 
strongly contracted — his pulse was tense and his breathing slightly 
stertorous. 

His head was shaved and examined, but there was no external 
wound, and no depression of bone could be perceived, but there was 
great eftusion of blood beneath the skin. 

Previous to his admission he had vomited and had been bled. A 
consultation was called, and it was agreed to cut down upon the bone 
in order to ascertain v/hether or not a fracture existed— this was at 
once done by Dr. Hewson, and it was found that the bone was unin- 
jured. It was now determined to treat it in the same manner as a 
case of apoplexy, and a branch of the occipital artery which had been 
divided in making the incision was allowed to bleed freely. 

A few hours after the incision was made the patient died. 

Examination thirty-six hours after death. — -The vessels of the brain 
were much congested, and a large quantity of clotted blood, thought 
to amount to six ounces, was found in the lateral ventricles. There 
was also some effusion of blood at the base of the brain. 

Case II. Abscess of the Brain. — John Gribi was admitted on the 
fourth of December, for a wound on the left side of his head, which 
he had received five weeks previously. 

A few days before he was admitted, he v/as attacked with convul- 
sions which were believed to be caused by the pressure of pus upon 
the brain, and he was sent into the hospital for the purpose of having 
an operation performed upon him. Upon examination of the wound it 
was found that there was a fracture of the bone with some depression. 

He was sensible, his pulse was slow and regular, his pupils were 
contracted, the whole of his right side was paralytic, and there was a 
great disposition to sleep. As he had no convulsions after coming into 
the house, and as he was sensible, an operation was not thought of, 
and a poultice was applied to the wound. He continued in this state 
till the morning of the 7th, when he became insensible. 

A consultation was now called, and it was determined to remove 
the portion of bone which was fractured, in order to ascertain whether 



306 Norris's Cases of Injuries of the Head. 

or not the compression was produced by pus between the dura mater 
and bone. Dr. Hewson accordingly enlarged the wound and used 
the trephine. No pus was found beneath the bone which was ad- 
herent to the dura mater. 

No change in the symptoms took place after raising the bone — sim- 
ple dressings were applied to the wound and a large injection and ten 
grains of calomel were given to him. Early on the next morning I 
found him with all the symptoms of apoplexy — a flushed face, a re- 
markably slow pulse, deep breathing and dilated pupils. He was now 
bled, sinapisms were applied to his extremities and another injection 
was administered. His pulse rose under the bleeding, his breathing 
became more natural, and his face less flushed, but a few hours after- 
wards he died. 

Examination twenty -four hours after death. — On removing the 
skull-cap a small quantity of pus was found between it and the dura 
mater immediately below where the trephine had been applied. 

On cutting into the left hemisphere of the brain an abscess was 
found, just below the surface, which extended upwards of two inches 
in one direction, and an inch and a half in the other, and contained 
three or four drachms of pus. An unusual number of red dots ap- 
peared in the brain, and the anterior part of its left side was softened. 
The vessels of the dura mater were injected. 

Case III. Fracture with depression, followed by inflammation of 
the Brain. — John M'Quiggen, aged twenty-six, was admitted January 
23d, with a wound on the back part of the left side of his head caused 
by a blow which he had received on the previous night from the sharp 
end of a spade. Upon examination it was found that there was fracture 
of the bone with depression. 

The skin was cool, and he was faint from the large quantity of 
blood which he had lost, but had no symptoms of compression of the 
brain. 

The wound was dressed with adhesive plaster, and to guard against 
inflammation of the brain he was kept perfectly quiet, was purged, 
and put on a very low diet. 

He had no unpleasant symptom till the night of the 28th, when he 
complained of pain in the head, to relieve which, as it was judged 
his pulse would not bear bleeding, cups were freely applied. 

On the morning of the 29th he became delirious, and continued so 
during the afternoon and evening; ten grains of calomel was now 
given to him and repeated in the night 



Norris^s Cases of Injuries of the Head. 307 

At 3 o'clock on the morning of the 30th he was insensible, had 
stertorous breathing and dilated pupils, and at 4 o'clock he died. 

Examination eleven hours after death. — The wound of the scalp 
was two inches in lengthy the bone was fractured for about the same 
length, and driven in upwards of a quarter of an inch upon the con- 
tents of the head — the dura mater was cut through, and the brain 
itself wounded. 

Portions of the posterior and middle lobes of the left side of the 
brain, and a portion of the posterior lobe of the right side were dis- 
organized. 

The membrane lining the lateral ventricles at their posterior part 
was inflamed, and about a table-spoonful of pus mixed with blood 
was contained in it. 

There was slight effusion of blood beneath the dura mater, at the 
top of the head, and also effusion at the base of the brain. The dura 
mater was inflamed. 

Case IV. Abscess of the Brain. — F. S. an insane patient in the 
hospital, was accidentally struck on the left side of his head by a 
quoit, on the 12th of April. 

Upon examination, it was found that the skull was fractured and 
driven in upon the brain. 

No symptoms of compression followed the blow, and after allowing 
the wound to bleed freely, it was dressed with lint, spread with 
simple cerate, and the usual means for preventing inflammation of 
the brain were resorted to. 

After a few days he had fever, attended with pain in his head, for 
which he was purged with calomel, had a solution of tartar emetic 
given to him, and cups, leeches, and cold applied to his head. His 
fever gradually left him, but on the 25th he appeared more dull than 
usual, and on the morning of the 26th had a chill, which was followed 
by a state of insensibility, and on the afternoon of that day he died. 

Examination twenty four hours after death. — The fracture was an 
inch and a half in length, and the dura mater beneath it was cut 
through. 

A thin clot of blood was found between the dura mater and the 
bone, and there was also slight effusion of blood beneath the dura 
mater. 

Immediately beneath the fracture an abscess was found, of the size 
of a large walnut. The whole brain presented fewer red dots than 
usual when cut into, and with the exception of that part just around 

27* 



308 Norris's Cases of Injuries of the Head. 

the abscess, which was much softer than usual, and of a light yellow- 
ish hue, was of the natural consistence and colour. 

The membranes of the brain were not at all injected, or their 
sti-ucture in any way altered. There was slight effusion of serum 
beneath the arachnoid, but none in the ventricles. 

Case V. Compression of the Brain from effusion of blood. — Charles 
Devenport, a coloured man, fell from a height of twenty-five feet on 
the morning of the 13th of August, and received an injury of his head, 
on account of which he was immediately conveyed to the hospital. 

When admitted, his skin was cool, his pulse feeble, and his pupils 
natural — his attention could be roused when spoken to loudly, but he 
was unable to answer correctly. 

Upon shaving his head, it was found that there was no external 
wound, but that there was great effusion of blood beneath the skin 
on the left side of the head. 

Sinapisms and heat were applied to his extremities, and cold to his 
head. 

In the latter part of the day he vomited bilious matter twicej his 
head was hot; pulse still feeble, and the insensibility greater. Ex- 
ternal stimulants were continued, and in addition to them, cups were 
applied to his temples. 

At 4 o'clock on the morning of the 14th he died. 

Examination twelve hours after death. — On cutting through the 
integuments a very large quantity of blood was found effused beneath 
the skin, and on removing the skull-cap, about ^ss. was found 
between the dura mater and bone at the back part of the head. 

Upon examining the skull a fissure was seen extending from the 
side of the foramen magnum up through the occipital bone to the sa- 
gittal suture, travelling up that suture about half its length, and 
from thence extending into the parietal bone of the left side for two 
inches. The sides of the occipital bone were separated from each 
other to the extent of a line. The longitudinal sinus of the dura 
mater had two wounds in it just above the torcular herophili, one of 
wliich was large enough for a common-sized quill to pass through. 
There was some effusion of blood beneath the pia mater on each side 
of the cerebrum, and also on the upper and back part of the cere- 
bellum. 

About an ounce and a half of blood was found under the pia mater 
at the base of the brain. The vessels of the brain were much con- 
gested, and a small quantity of bloody serum was found in the ven- 
tricles. 



Norris's Cases of Injuries of the Head. 309 

Case VI. Compression of the Brain from depressed hone. — Ed- 
ward Morris, a coloured boj, aged fourteen, was admitted into the 
hospital, August 25th, with compression of the brain. A few hours 
before his admission he had been struck upon the upper part of the 
left parietal bone with a sharp stone, which had produced a large 
wound of the scalp and fracture of the bone. 

The persons who brought him to the hospital stated, that imme- 
diately after the receipt of the injury he walked a short distance and 
then fell in a convulsion: from that time till brought into the house 
he had had several convulsions, and when free from them he remain- 
ed in a state of complete insensibility. Previous to his admission he 
had been bled. 

Dr. Barton was in the house at the time of the admission of the 
patient, and at once enlarged the wound, which bled very freely, 
and exposed the injured bone, which was driven in, and formed as 
it were an inverted arch. As there was no fissure whereby the ele- 
vator might be got under the bone, the trephine was applied, and 
the depressed bone raised. 

Upon raising the bone no pulsation was seen in the brain, but in 
the course of a few minutes the convulsion which he had went off, 
and the brain began to pulsate. He had three convulsions after the 
depressed bone was raised, and each time during the continuation of 
them there was an entire cessation of pulsation, but upon their going 
off the pulsation would again recommence. 

The wound was lightly covered with a soft poultice, and as his 
skin was cold, heat was applied to his extremities. 

After re'action had come on, thirty-five leeches were put upon his 
temples. 

Although free from stertor, yet his insensibility continued till late 
in the afternoon. 

By night he was completely sensible, and it was discovered that 
his whole right side was paralytic. 

August 26th. — Has no pain in his head; pulse good; skin comfort- 
able; is able to use the lower extremity of the right side; is not able 
to raise his arm, but has the proper feeling in it, and can move his 
fingers. His diet was directed to consist of mucilages, and a solu- 
tion of cream of tartar was given him for drink. 

27th. Has complete command of the right side of his body. Com- 
plains of his head feeling hot, but has no pain in it; pulse rather fre- 
quent. Took §x. of blood from him, and ordered 5ss. of salts to be 
given to them, which operated freely. 



310 Young on the Cimicifuga Racemosa in Chorea. 

QSth. No pain in the head; wound is suppurating freely and looks 
well; pulse good. 

50th. Improves; pulse natural. 

Sept. 5d. Continues to improve. The dura mater is now covered 
with granulations, and the wound is filling up rapidly. From this 
time his diet was gradually increased, he improved regularly, and by 
the 20th of October the wound was entirely healed. 



Art. V. Observations on the Remedial Powers of the Cimicifuga 
Racemosa in the Treatment of Chorea. By Jesse Young, M. D. 
of Chester County, Penn. 

Chorea SANCTI VITI, although of not very frequent occur- 
rence, or of an immediately dangerous tendency, is generally an ex- 
ceedingly obstinate and intractable disease, and sometimes persists 
for months or years, inducing loss of appetite, anxious and dejected 
countenance, extreme debility, and what is most distressing, a gra- 
dual declension of the mental faculties, and the hideous prospect of 
its terminating in complete and permanent imbecility or fatuity. Such 
being the case, I have thought that it would be interesting to make 
known the remedial powers in this disease, of a plant, which, so far 
as I know, has not been recommended by any one who has written 
on the subject, and which has proved completely, and very promptly 
effectual, mfour successive cases, in which I have known it used; 
although only one of them was under my own particular care or di- 
rection; I can however vouch for the entire correctness of the state- 
ments of the other cases. 

The article referred to is the pulverized root of a very common 
vegetable production of our rich woodlands, known by the common 
or familiar name of black snakeroot. Its technical name as given by 
Darlington, quoted from Elliott, is Cimicifuga racemosa, called 
by PuRSH, Cimicifuga serpentaria, and by Willdenow, Muhlen- 
berg, and MicHAux, ^ctea racemosa. I subjoin its botanical charac- 
ters from the Florula Cestrica of Dr. Darlington. Class Polyandria, 
Order Di-pentagynia. Calyx four or five-leaved; corolla four-petal- 
led; capsules one to five, oblong, opening along a lateral suture; 
many-seeded; monogynous; leaves decomposed; racemes virgately 
paniculate; common in rich woodlands; flowers latter end of June; 



Young on the Cimicifuga Racemosa in Chorea. 311 

four to six feet high^ flowers white. "It is a very popular medicine 
both for man and beast; it is used in infusion or decoction, chiefly as 
a pectoral medicine," &c. Perhaps there is no country physician 
but will acknowledge the truth of the above, and perhaps too, they 
will agree in the assertion, that "its properties have probably been 
overrated" in the affections in which it has heretofore been used. 
Who first used it in chorea, I have no means of learning, but it came 
to my knowledge as related below. 

Four years ago a son of Mr. Joseph Fairlamb, aged about eleven 
years, was attacked with chorea; one side was aff*ected, and was in 
almost constant motion, except when he was asleep. He was affect- 
ed with it more than four months, during all which time his family 
physician was using all his efforts to arrest it, but without the least 
benefit resulting. He at length was informed by an old woman in 
the city, to whom he was speaking of the distressed situation of his 
son, and not consulting her as a doctress, that the pulverized root of 
the black snakeroot would cure it. She told him to give a tea-spoon- 
ful three successive mornings, then omit it three, and thus give it alter- 
nately three mornings together, until he gave it nine times. He pro- 
cured a quantity from a drug store, and commenced its use immedi- 
ately on his arrival at home, according to the old lady's directions, 
and he lately assured me that when the boy had taken six portions 
he was almost well; and when he had taken his nine portions he was 
perfectly cured, and has remained so ever since. I heard of the case 
and its cure about the time it occurred, but having no confidence in 
such a remedy for such a disease, it only brought to mind the adage 
post hoc, &c. and I thought no more of it at the time. 

In the month of March of the present year, a daughter of Mr. 
Isaac Hall was attacked with the same disease. His family physician 
was called to the case, and after treating it for about a month, 
without any good resulting, his physician agreed to let him make use 
of the snakeroot, as he had heard of its good effects in the above 
case. It was procured, and used as above, and after taking only 
three portions her symptoms were very much improved, and after 
taking six doses she was entirely well; the other three were however 
given, and she remains well at this time. In this case it puked se- 
verely, almost every time it was given. I now supposed that proba- 
bly it was the emetic effect of the article which was beneficial; but on 
inquiry of Mr. Fairlamb, whether it operated so with his boy, he 
assured me it did not; but that it "several times, though not always," 
made him very sick. I now determined to try it, in the first case I 
might meet with, watch its effects, and thus ascertain whether it 



312 Young on the Cimicifuga Racemosain Chorea. 

would cure by its own intrinsic properties, or whether those reputed 
cures, might not be mere coincidences, and in reality the consequences 
of perhaps former treatment. On the 12th of September an oppor- 
tunity for trying it occured; I was requested to see Mrs. , aged 

nineteen years^ married about two months, believed not to he pregnant. 
The affection had commenced about two weeks ago, but came on so 
gradually, and almost imperceptibly, that she was not aware of any 
thing serious being the matter, till within a day or two, she has got 
so bad as to be almost constantly in motion, with the leftside^ it does 
not prevent her from sleeping at night; her general health is perfectly 
good, in every respect; and on the most minute inquiry, I could not 
detect a single cause which might occasion it; save only, her father 
had once been affected so, when a boy; in his case it was produced 
by fright, and he was cured, or got well in between two and three 
years, after using much medicine without benefit; but believes 
it was the cold bath that cured him at last. Whether this fact 
might account for it, others must determine. I ordered an emetic 
of tart ant. with a view to its impression, rather than its eva- 
cuant effect, to be succeeded by a large portion of colomel and 
jalap, next day; and after this, to purge every morning with crem. 
tart, et jalap, till I could procure the snakeroot. On the 20th I took 
a quantity of it to her; but was actually startled, when I found the 
affection had extended to the other side, and was tenfold aggravated; 
her arms, her legs, her head, face, tongue, and every muscular part 
of the system appeared to be in continual, irregular, alternate mo- 
tions; she could only with great difficulty articulate, so as to be at 
all intelligible; the power of deglutition was suspended to a very great 
extent; she could not walk one step, nor support herself erect without 
assistance, nor could she sleep, day or night, on account of the con- 
stant twitching and jerking of the muscles. This was her distressing 
situation when she commenced the use of the snakeroot. I ordered 
her to take a tea-spoonful three times a day^ before eating; but if it 
sickened her, on trial, when taken on an empty stomach, to take it 
an hour after meals; to be taken in whatever she preferred, as sweet- 
ened water, molasses, &c. On the 25th I visited her again, and 
found a great change for the better; she had walked ^^he day previ- 
ously, three or more hundred yards from the house; she could speak, 
and swallow, as well as ever she could, and could sleep well at night; 
her inferior extremity had but little irregular motion, her head was 
steady, and the muscles of the face was scarcely agitated; but her 
arms appeared more affected now than any other part. Encouraged 
by this mitigation of symptoms, I requested the article discontinued 



Young on the Cimicifuga Racemosa in Chorea. 313 

two or three days, and then to commence again, with a tea-spoonful 
and a half, as before. Visited her October 2d, found her so well that, 
a person who was not aware of her having the affection, would not 
notice any thing ailing herj still, however there was an occasional 
jerking in the arms; I requested it left off again for two or three days, 
and then to recommence, as last ordered, except to take it twice a day 5 
she used it two days more, regularly, and then took an occasional por- 
tion sometimes once or twice a day and sometimesnot, for one week, 
at the end of which time she discontinued it, being perfectly well, and 
she remains so at this time. 

During my different visits, I repeatedly inquired whether it acted 
as an emetic or sickened her at any time; she uniformly replied it did 
not, except two or three times when taken on an empty stomach; 
neither did it purge, but her bowels were uniformly regular while 
using it; it neither sweated her, nor acted as a diuretic; how it did 
act I would not determine, as I could not discover any alteration in 
the pulse, while under its influence. I however incline to the opinion, 
that it cured by an immediate and direct impression on the nerves, 
rather than by any tonic effect. The only sensation the patient ex- 
perienced was an ''uneasy feeling," amounting to ''almost an ache" 
through all her extremities, every time she took it, which would con- 
tinue from one to three or four hours. This was all I could learn 
respecting its modus operandi; but that it alone cured must be ob- 
vious to every one. 

The effects of it in the fourth case, I was informed of by my friend 
Dr. Richard Gregg. I inquired of him whether he met with any cases 
of chorea, and informed him of the results of the foregoing cases. He 
replied "I should have had a case, a short time ago, had it not been 
for the black snakeroot;" he observed that a man in whose family he 
practiced, met him in the road and informed him of one of his chil- 
dren having St. Vitus's dance; but he had heard of Mr. Hall's daugh- 
ter having been cured by the snakeroot, and he was then on his way 
to see Mr. H. and learn how to use it; adding, if it dontcure I shall 
have to call you to see her. He saw the man a short time after, and 
learnt that the patient had been cured in a few days by the article. 

The results of these cases, will certainly justify the inference, that 
it possesses controlling powers, to some extent, over the disease; to 
suppose that it will always cure, is perhaps too much to expect from 
any one remedy. My particular object in communicating them so 
minutely, is simply to state the facts of the cases, with the hope of 
directing the attention of the faculty to the article, and thus have it 
submitted to the test of a more enlarged experience, than could pos- 



314 Young on the Cimicifuga Racemosa in Chorea. 

sibly fall to the lot of any one individual. If on repeated trials, it 
should be found really valuable, its peculiar effects, whether tonic, 
sedative, or whatever else they may be, can, by watching, be ascer- 
tained ^ and may we not hope, that by the aid of chemistry, its active 
principles can be detected and separated from those which may be 
inactive; and that we may thus be put in possession of a cheap and con- 
venient article, which may possess virtues, in the treatment not only 
of chorea, but of many other of those most troublesome of all diseases, 
the neuroses. 

The idea of the knowledge of its efficacy being derived from an old 
woman, should not, in my estimation, operate against the article so 
far as to prevent its having a fair trial. I believe the old lady was 
not & professed doctress; but if she were, the knowledge if it prove 
valuable is none the worse for coming from such a source. What 
physician has not, and does not, derive many ideas from old women, 
which are in reality, practically valuable.^ and it cannot but be ac- 
knowledged, that from such sources, and from mere accident, the 
knowledge of many of our most valuable remedies have been derived, 
which are now engrafted into, and form a part of the general stock 
of the science of our profession. If I know my own mind, I am not 
fond of, nor very prone to, quackery; and, although I freely confess 
this article was used without any knowledge whatever of its modus 
operandi, or without knowing what to expect of it, other than probably 
a cure, it did not disappoint the latter expectation; and I now feel 
sufficient confidence in it to try it again, if opportunity occurs, and to 
hope that others will do likewise. If this be quackery, and it be jus- 
tifiable in any case, it may be so when applied to the investigation of 
the properties of our indigenous vegetables; but it is not, else the 
therapeutic part of our profession has scarcely any other foundation 
to rest upon, than a grand system of empiricism; for the history of 
almost the whole materia medica shows, that from such sources 
have been derived our most valuable agents. The investigation of the 
medical properties of our vegetable substances, then, should rather 
be considered laudable, when directed with the viewof enlarging the 
boundaries of our knowledge, and thus adding to our resources, than 
condemned, because forsooth, they may have been the suggestions of 
vulgar ignorance, or even of empirical experiments, rather than the 
recondite inquiries of professional erudition. But neither a priori rea- 
soning, nor professional erudition, can ever direct us to the peculiar 
properties or effects of any of our vegetable productions; they can only 
become known from repeated trials, or experiments. In this class 
exactly, stands the Cimicifuga racemosa, in chorea, and probably in 



Geddings on Debility. 315 

other of the nervous affections. Let it be fairly tried then, and on 
these trials let its merits stand or fall. 

Chester, Pa, Oct 9.9th, 1831. 

[We are not aware of the remedial powers of the black snakeroot 
having been noticed by any writer on the materia medica, but Dr. 
Physick informed us, nearly ten years ago, that he had known that 
plant, given in doses of ten grains every two hours, prove successful 
in the treatment of chorea, in several instances.] — Editor. 



Art. VI. Observations on those Pathological States of the System 
generally designated Asthenia, Adynamia, Debility, Weakness, 
^c. By E. Geddings, M. D. Professor of Anatomy in the Uni- 
versity of Maryland; one of the Surgeons to the Baltimore In- 
firmary, &c. 

1 HE condition of the living organization which is manifested by a 
deficiency of power, or a preternaturally feeble exercise of the func- 
tions, and hence designated debility, asthenia, adynamia, weakness, 
&c. has been attentively observed from the earliest period of the 
world, has excited dread and consternation in the minds of physi- 
cians, unnerved the most Herculean powers of both mind and body, 
and has been accused of constituting an immense outlet of human exist- 
ence, yet with all our observations and reflexions we are ignorant of 
its most important laws. Much of the diflBculty which exists in rela- 
tion to the subject is doubtless owing to the imperfect and ill-defined 
ideas which we attach to the condition itself; but more, unquestion- 
ably, to our ignorance of the fundamental laws of the organization. 
Debility, it must be confessed, is a mere relative term, and cannot 
be said to express, with accuracy, any positive condition of the func- 
tions, or of the structures by which they are performed. Thus, what 
would be weakness with one individual would be strength with an- 
other differently constituted, and by examining the play of the func- 
tions in several persons endowed with various temperaments, con- 
formations, habits, &c. we shall observe an infinity of modifications 
in their physical powers, yet all consistent with perfect health. This, 
however, is not precisely the kind of debility or weakness with which 
we are most concerned. " Good health," says John Brown, " con- 
sists in a pleasant, easy, and exact use of all the functions. Ill 
health in an uneasy, difficult, or disturbed exercise of any or all of 
No. XVIIL— Feb. 1832. 28 



316 Geddings on Bebility. 

them." It is, then, when the debility is of that kind which consists 
in such a degree of departure from the healthy state as to constitute 
disease, or, in other words, to become pathological, that it most in- 
terests us; and it is to this degree, or modification of it, that most of 
our observations will have reference. It is to this state that the terra 
asthenia has been applied by some, and that of adynamia by other 
pathologists. 

But we are yet met by the question, what is this asthenia or ady- 
namia? Upon what state of the organization does it depend? What 
are its causes, tendencies, and the laws of its extension throughout 
the system? These are questions which can only be answered by de- 
termining the circumstances which attend the healthy operation of the 
functions, and, afterwards, the manner in which these become de- 
ranged or perverted so as to give rise to the want of power in 
question. 

•Every living organized being is endowed with a principle which 
renders it susceptible of the influence of stimuli, and when acted 
upon by external and internal agents, the result of the mutual con- 
flict between the organization and the causes which influence it, or 
between the excitability, or susceptibility, and stimuli, is the deve- 
lopment of a phenomenon or condition which we designate irritation. 
All vital phenomena must, therefore, be referred to this source. Un- 
der whatever aspect we contemplate them, irritation presents itself 
as their constant and predominant characteristic, and to its different 
modifications must be ascribed the endless varieties of healthy and 
diseased conditions. A knowledge of this law led John Brown to af- 
firm, that life is a forced state; for, says he, if the exciting powers 
be withdrawn, death ensues as certainly as when the excitability is 
gone. But while we admit that the entire organization is thus en- 
dowed, it must not be conceded that its susceptibilities are equally 
active in its several parts. This property depends upon the perfec- 
tion of the organization; its supply with blood-vessels, nerves, &c.; 
and. as the several tissues present much diversity in this respect, so 
there is great variety in their comparative capabilities of receiving 
external impressions, and acting under their influence. This circum- 
stance is the source of an important error in the doctrine of Brown, 
who maintained that excitability is an unit, and, consequently, that 
excitement must also be an unit, and may be either general, or pro- 
ducing an universal impression throughout the entire system, or lo- 
cal, and confined to a single part. If the law of the organization 
which we have alluded to be well founded, it necessarily follows, 
that no impression can be at first universal; or, as has been aflBrmed 



Geddings on Debility. 317 

with truth by Broussais, "there can never be either a general and 
uniform exaltation or diminution of the vital properties of the organi- 
zation.'^^ In every case the exaltation or diminution commences with 
some one system or organ, from whence the influence is extended to 
other systems or organs, either directly or indirectly. The order and 
degree in which any particular part of the body will be implicated, 
or made to feel the influence of the causes acting upon the organiza- 
tion, will depend, measureably, upon its susceptibility and the inti- 
macy of its sympathetic relations with the other parts. Thus, the 
capital systems or organs, if we may thus express ourselves, as the 
digestive, circulatory, and nervous, are the parts which most readily 
feel the influence of external impressions, and transmit them with 
most facility, reciprocally from the one to the other; because they 
are not only the most exquisitely organized, and consequently pos- 
sess the highest degree of susceptibility, but are, at the same time, 
united together by the most intimate sympathetic relations. 

But although no agent can affect the organization equally and uni- 
versally at the same time, there is nevertheless a certain relationship 
between the operation of its different parts — a certain equipoise of the 
functions in which perfect health consists. As excitability, suscepti- 
bility, receptivity, &c. as it has been designated, is the fundamental 
quality or property of living matter, to which all vital phenomena 
must be referred, so is contractility the proximate quality or pro- 
perty by which all these phenomena are accomplished; and the action 
of stimuli upon the excitability calls into existence the contractility 
of the tissues, the manifestations of which constitute irritation, which 
we have already defined. By vital contractility, the shapeless em- 
bryo is unfolded and perfected in all its parts; the heterogeneous par- 
ticles, derived from our aliments, are animalized, and transformed 
into living structures; and by the same power they are again thrown 
off", as excrementitious, through the diff*erent waste-sluices of the sys- 
tem. By this power the nerves feel, the mind perceives and wills, 
and the muscles act obedient to its volitions. The indispensable con- 
dition of our existence is an incessant state of exertion — a ceaseless 
state of action and reliction, without which the wheels of life would 
stand still, and all our wonderful machinery would be brought to the 
condition of shapeless and inanimate masses, and be speedily resolved 
into a few primitive elements as insignificant as the dust we tread 
under foot. Can it then be wondered that actions so delicate, mecha- 
nism so complex, operations so perpetual, should often become irre- 
gular and discordant, and thus endanger our safety.? Life, in its per- 
fect state of integrity, is, indeed, as represented by Cuvier, <«a 



318 Geddings on Debility. 

perpetual vortex, the direction of which, however complicated, is al- 
ways the same." But when this state of unison becomes deranged, 
the direction of the vortex is necessarily changed, and we too often 
become swallowed up in its conflicting elements. 

As stated in the outset of our observations, we only propose to 
consider that derangement of the harmony of the vital properties of 
the organization which consists in an enfeebling or diminution of its 
powers. But what are the principal modifications or varieties of this 
state? This is a question upon which the sentiments of pathologists 
are much divided ^ some making as many varieties of debility as there 
are modifications of its manifestations, while others, considering ex- 
citability as an unit, only make debility the negative state of excite- 
mentj and some only having reference to its remote causes, have 
made forms of debility as numerous as the causes by which it is pro- 
duced. Sauvages,* acting upon these principles, has made seven- 
teen varieties of asthenia, and VoGELt has arranged under this head 
every abolition or diminution of the energy of sensation, voluntary 
motion, and the natural functions; while Cullen has restricted his 
definition to an enfeebling of the voluntary movements, either of the 
vital or animal functions. Brown, Darwin, and Rush, however, 
only make two forms of debility, direct and indirect; or as the latter 
has expressed it, debility from abstraction and debility from action. 
HuFELAND,:}: on the contrary, acting upon a diff'erent view, divides it 
into true and apparent or false, and he says it may take place either 
from an oppression of the vital powers, or from some alteration of 
the nervous sensibility. Broussais considers it in most instances as 
secondary, except where it arises from abstraction of stimuli; and 
Rasori, Tommasini, and others of the modern Italian school, admit 
that it may be primary or secondary, according as it is the result of 
contra-stimulant or stimulant impressions. Boisseau,§ who has writ- 
ten with ability on the subject, considers it according to the manner 
of its production, from whence he concludes it may originate from 
the three following circumstances: 1. From a complete or prolonged 
abstraction of the accustomed stimulus; 2. The diminution of the reci- 
procal stimulating influence of the organs; and 3. From the inordinate 
excitation of an organ, the slightest alteration of which renders the other 
organs incapable of acting with an equivalent energy. Brachet,|| in 

* Nosologia Methodica, Tom. I. p. 699. Amstelodami, 1768. 
f Definitiones Generum Morborum. Gbtling', 8vo. 1764. 
4 Encyclopadisches Wbrterbuch der Med. Wissen. Band 1. 
§ Dictionnaire Abrege des Science Med. Art. Asthenic. 
I Memoire sur 1' Asthenic, Paris, 1829. 



Geddings on Behility. 319 

a prize dissertation on the condition under consideration, affirms 
that asthenia can only manifest itself in consequence either of a di- 
minution of the action of the cerebro-nervous system, consisting in 
an enfeebling of its special functions, or of the functions over which 
it presides, or of a diminution of the activity of the functions which 
depend upon or are under the influence of the ganglionic nerves. 
This weakness of the nervous system, he thinks, may arise either 
from a deleterious alteration of the blood, or from a considerable di- 
minution of its quantity. 

Without entering into any discussion upon the validity or incon- 
sistency of any of these opinions, we shall proceed at once to detail 
our own views relative to the nature and consequences of asthenia. 
In considering the subject we shall pursue a course somewhat differ- 
ent from that which has generally been adopted, and employ a phra- 
seology at variance with that which we have seen was used by Brown, 
Darwin, and Rush. 

For the sake of description we shall divide debility into direct, in- 
direct, and metastatic, not employing the two first terms, however, 
in the same sense in which they were used by Brown. He confined 
his definition of direct debility to that which proceeds from an ab- 
straction of stimuli, while in addition to this, we shall include under 
that head, the debility which arises from those causes, which, by 
their contra-stimulant influence, directly enfeeble the organization. 
By indirect debility, we mean as well that weakness that arises from 
exhaustion, or fatigue from overaction, as that which takes place in 
consequence of a prejudicial deterioration of the nutritive molecules 
of the blood, in consequence of impressions first made upon the liv- 
ing solids, which, by their modified or perverted operations on their 
contained fluids, alter their properties. The term metastatic debility, 
(debilitas metastatica,) was employed by Hufeland to represent that 
state of debility which proceeds from a transfer of diseases, especially 
those of a cutaneous character.* By it we wish to designate that form 
of asthenia which takes place when one organ is inordinately irritat- 
ed, and thus concentrates a portion of the irritation of the others in 
a focus, leaving them in a minus state of excitation. With these pre- 
liminary definitions, we shall proceed to consider the different forms 
of debility which have been enumerated, taking them up in the order 
in which they have been detailed. 

* Encyclopadisches Wbrterbuch der Med. Wiss. Band 1, 453. 
38* 



320 Geddings on Debility, 

§ 1. Direct Debility, 

It is needless we should saj much of the first variety of direct de- 
bility, or that which proceeds from the abstraction of stimuli, as in- 
stances of it are too numerous to require any particular exemplifica- 
tion. The humbler walks of life, where squalid poverty and indigence 
prevail extensively, present unfortunately too many examples of de- 
bility from the abstraction of stimuli. The pallid and emaciated 
form, the flaccid and inactive muscle, the impoverished and almost 
colourless blood, the general imbecility of the mental faculties, toge- 
ther with the universal breaking up of the vital forces, too clearly 
proclaim, that under these circumstances the proper quantity of the 
pabulum vitse is not furnished to nurture and sustain the flame of life, 
which, being gradually exhausted, either flickers away for want of 
sustenance, or is at once extinguished by the influence of mortal dis- 
eases, generated by the unnatural and restrained circumstances un- 
der which it is placed. Asthenia from this cause is fortunately not of 
frequent occurrence in this country: but in other sections of the 
globe, in which either from a native sterility of the soil, an overgrown 
population, or habits of indolence, a sufficient quantity of healthy 
sustenance is not furnished to satisfy the demands of nature, asthe- 
nia of the kind in question often prevails to a deplorable extent, and 
becomes a fruitful source of disease and death. It is, indeed, under 
these circumstances, that the most formidable pestilences are usually 
generated, and in camps, prisons, garrisons, &c. this cause operates 
so extensively, as often to constitute one of the principal calamities 
of war. ♦ 

But it is not the abstraction of sustenance alone that gives rise 
to consequences thus deplorable. They may take place even where 
the quantity is considerable; but where the quality is not suited to 
the exigencies of nature. Man seems to require, to ensure the full 
development of his physical forces, a due admixture of vegetable and 
animal diet, as it has been satisfactorily proved, that an exclusive use 
of the one or the other of the substances is highly unfavourable to the 
attainments of this end. The Burats, who subsist on food almost 
exclusively animal, we are told by Pallas, are remarkably effeminate, 
and are so weak and small of stature, that five or six Burats are often 
incapable of accomplishing what a single Russian can effect. Con- 
trary, moreover, to what has been often asserted and believed, mus- 
cular energy is more feebly developed in savage life than in a state 
of civilization. This proposition has been fully established by the 
observations of Collins, Cook, Peron, and others. In the native 



Geddings on Debility, 321 

inhabitants of Van Dieman's land, who subsist measureably upon 
fish and insects, the muscular power was found by Peron, on several 
trials, to be less, \>J almost one-third, than in the English. The ab- 
straction of air, light, heat, and electricity is capable of producing 
results similar to those which arise from the abstraction of food and 
drinks. There is, however, one circumstance connected with the 
abstraction of food and drinks, which is somewhat curious: — that the 
latter are much more important for the preservation of life than the 
former. It was long ago observed by Hippocrates, that an abstinence 
from food can seldom be endured beyond seven days, without in- 
ducing death. The allowance of a small quantity of water has, 
however, been known to protract existence considerably beyond that 
period. Redi* found by experiment, that fowls deprived of both 
food and drink, did not subsist beyond the ninth day, while the same 
animals, supplied with water alone, sometimes lived twenty-one days. 
The human subject has been known to subsist for a longer period on 
water, without any thing like food. But in all cases, a deficiency of 
the one or the other is productive of great distress. When intense 
hunger or thirst is protracted for any great length of time, the head 
and stomach become painful^ fever, jaundice, and delirium supervene^ 
an overwhelming debility takes places the features shrink^ the teeth 
become covered with a black sordesj the saliva bitter 5 the breath of- 
fensive; the urine acrid and scalding,! and life is terminated under 
the most horrid suflferings; or if preserved by an allowance of food, 
the individual generally suffers a dangerous and protracted disease, 
generated by the intense degree of asthenia, by which his powers are 
overwhelmed. 

The influence of the exclusion of light and air on animal, and even 
vegetable life, is well known. Cut off from these sources of stimuli, 
the vegetable droops and languishes; its growth is interrupted; its 
parts are imperfectly unfolded; it is unable to put forth its rich and 
luxuriant foliage; the native brilliancy of its colours grows pallid and 
sickly; it withers away like the '' sear and yellow leaf of autumn," 
"and perishes and passes." — Light is indeed so essential to the ex- 
istence of many vegetables, that they turn their expanded disks to the 
bright orb of day, and drink in, from his brilliant rays, their life and 
animation. Others fold in their rich petals and foliage at the approach 
of evening, and during the reign of darkness, seem to repose in a 
state of torpor, until again aroused to life and activity, by the return 



* Osservazionl intorno agli Animali viventi, &c. Firenze, 1684, p. 92. 
t Rudolphi Grundrisse der Physiologie, Band. 3, Berlin, 1828. 



322 Geddings on Behility. 

of the genial influence of the morning sun. Animated nature, too, 
participates in this paralyzing influence of darkness, and this vivifying 
controul of light. As night comes on, the sweet warblings of the 
songsters of the grove gradually die away; the lowings of the herds 
are hushed 5 the fowls retire to rest, and even man, wearied by the 
cares and toils of day, and enfeebled by the empire of darkness, is 
gradually weighed down by sleep, and overwhelmed in sweet forget- 
fulness. 

Cut oft* from the pure vital air of heaven, man cannot exist, and 
even a partial abstraction of this important principle speedily en- 
feebles the physical forces to an alarming degree. Were any illus- 
trations of the induction of asthenia from this cause necessary, a most 
melancholy source is furnished by the account of the suff*erings of some 
English prisoners, who were confined in the black hole of Calcutta. 
Of one hundred and forty-six individuals thrust into this miserable 
prison, which was only about eighteen feet square, and deprived of 
every source of ventilation, except by two small grated windows, only 
twenty-three survived, at the expiration of about ten hours, and they 
in such an enfeebled state, that when an order was received for their 
release, it was with much difficulty the piles of the dead could be 
removed, which had become heaped up against the door. They suf- 
fered the most indescribable tortures, from which they were only 
released by death, or a state of insensibility. 

The abstraction of heat is another fruitful source of asthenia, which 
should be ranked under the head we are now considering. Moderate 
degrees of cold have been supposed to invigorate the system, and if 
we may judge from the constitutions of those who inhabit temperate 
regions, the conclusion would seem to be just. But it must be re- 
membered, that the intense degree of heat, which is endured in tro- 
pical regions, debilitates by exciting inordinately the powers of life, 
and by thus occasioning an excessive discharge of the fluids of the 
body. The greater vigour, therefore, of the inhabitants of higher 
regions, is merely owing to their living in a temperature more con- 
genial to the susceptibilities of the system, and their not being ex- 
posed to the debilitating influences just mentioned. The well-known 
effects of an intense degree of cold are to produce an alarming de- 
pression of the vital forces, and even an extinction of life. This is 
manifested in various ways; as for example, in the languishing circu- 
lation, a diminution of animal heat, a loss of muscular energy, a com 
plete extinction of sensation and reflection, and finally, death. The 
whole of the energies are rapidly subdued, and the stoutest heart 
cannot bear up. An irresistible disposition to sleep seizes upon the 



Geddings on Dehility, 328 

individual, which no efforts, or admonitions, or remonstrances can 
subdue; and he quietly falls into the slumbers of death. The debili- 
tating influence of cold is, indeed, sometimes so powerful, that birds 
are often known to fall down benumbed and helpless, or stitt' and 
dead; and even the polar bear, destined by nature to live in the ice- 
bound regions of the Arctic circle, not unfrequently falls a victim to 
the debilitating influence of the intense cold of his native skies. 

But, perhaps, a more important variety of direct asthenia or de- 
bility, is that which is produced by the operation of contra-stimulant 
agents, or those causes which tend, by their peculiar properties, to 
produce a direct depression of the powers of life, independently of 
any negative property or quality. 

Brown laid it down as an axiom, that all agents which are capable 
of affecting the organization, produced their results by a process of 
stimulation. In this opinion, however, he has not been sustained by 
subsequent observations. Indeed, experiments have satisfactorily 
demonstrated, that there are an immense number of agents which 
produce an impression directly opposed to that of stimulation, or en- 
feeble or depress the vital forces, by an operation which is direct, 
and unpreceded by any excitement. These have been called, by the 
modern Italian physicians, contra-stimulants. Of the several causes 
which act thus upon the animal organism, some produce their effects, 
as it were, instantaneously, and in a moment, extinguish the pow- 
ers beyond recovery; others act more tardily, and merely produce a 
gradual diminution of the vital energies. Even a single drop of prussic 
acid, merely applied to the surface of the eye of a dog, or to thetongue^, 
produces death in three or four seconds, and injected into the veins 
of an animal, it extinguishes life in an instant, as by a stroke of 
lightning, leaving the muscles almost entirely devoid of all traces of 
irritability. All substances, possessed of narcotic properties, enfeeble 
the powers of life, and produce a degree of asthenia which is some- 
times alarming, and even fatal. The nervous susceptibility is anni- 
hilated; sensation is enfeebled or obliterated; the pupil is widely 
dilated, the eye is insensible to light; the mind becomes incoherent, 
or is overwhelmed with a general stupor and coma; the pulse flutters, 
or is scarcely perceptible; the respiration is slow and heavy; a general 
coldness diffuses itself over the body; the muscles are agitated with 
tremors, or are flaccid and inactive; and death is gradually induced 
by the overwhelming debility which pervades the organization. These 
effects arise from the operation of a great diversity of agents, and are 
almost always induced by an inordinate dose of opium, hyosciamus, 
belladonna, tobacco, &c. Indeed, all these substances possess the 



324 Geddings on Debility. 

property of enfeebling, or extinguishing the irritability of the organi- 
zation; and thus, by rendering it insusceptible to the impressions of 
the ordinary stimuli which act upon it, either occasion an alarming 
degree of debility, or even death. Himly found by experiment, that 
a solution of opium, applied to the brain or the stomach, completely 
destroyed the irritability of the heart in the short space often minutes; 
and many of the irrespirable gases, as the sulphureted and carbureted 
hydrogen, the carbonic acid, &c. are known to produce the same ef- 
fect with great promptitude. Indeed, the researches of Bichat have 
satisfactorily shown, that even the black, or undecarbonized blood, 
when brought in relation with the left side of the heart, completely 
paralyzes its energies, and arrests its contractions. An impure atmos- 
phere always contributes to give rise to more or less debility, and in 
some situations, especially those which are exposed to miasmatic 
exhalations, the enfeebling and undermining influence of this cause 
is very strikingly manifested. We are aware that there has been some 
differences of opinion relative to the primary operation of malaria, 
some conceiving it to be debilitating, while others have maintained 
that it is always stimulating,- but if we attend to the manifestations 
attendant upon its action, every thing will be found to favour the first 
of these opinions. Under all circumstances the internal and external 
cutaneous surfaces, or the mucous membranes and the skin, are the 
recipients of all impressions developed by this peculiar impalpable 
material, and whenever exposed thoroughly to its influence, we find 
their functions impaired or suspended, or submitted to a deranged 
or perverted action, proportionate to the intensity of the cause acting 
upon them. Their susceptibilities are blunted; their secretions are 
suspended or diminished in quantity; their circulation languishes; 
a general stupor and inappetency seizes upon them, and thisinfluence 
being gradually extended to the other systems, the natural vigour and 
harmony of their functions become disturbed and broken up, and a 
profound asthenia overwhelms and paralyzes as it were the energies 
of the living organism. The sunk and pallid countenance, the flaccid 
and tremulous muscle, the languid circulation, the imperfect calori- 
fication, the sluggish sensibilities, and the general imbecility of the 
mental and corporeal energies of those who have been long exposed to 
the influence of an atmosphere abounding with these poisonous ex- 
halations, too clearly prove, that their effects are powerfully debili- 
tating and that they cannot be referred to a stimulant impression. 
It is indeed in this manner that they become such a prolific source of dis- 
ease, and lay the foundation for such serious and irreparable ravages 
upon our organs. Many of the metallic salts, moreover, seem to ex- 



Geddings on Debility. 325 

ercise a debilitating influence upon the living organization. This is 
especially the case with antimonj and lead, the latter of which, indeed^ 
•when pushed to any extent, is capable of producing a complete pa- 
ralysis of the muscles. To these causes must be added the influence 
of the depressing or debilitating passions, which sometimes prostrate, 
in an instant, the whole of the powers of the system, even beyond 
recovery. The operation of fear, especially, tends powerfully to en- 
feeble the powers of life, and under its agency even the stoutest 
heart is made to quail, and the bravest cheek grows pale and lifeless. 
The muscles are instantaneously bereft of all powers the life blood 
retreats from the surface; the heart palpitates; a mortal coldness dif- 
fuses itself through the system; an icy sweat breaks out upon the sur- 
face; the senses wander; the intellect is dethroned; the volitions an- 
nihilated; and a general syncope, in some instances, paralyzes all 
the organs and functions. Sometimes, indeed, vitality becomes ex- 
tinct, being annihilated as it were by the overwhelming influence of 
the debility which suddenly takes possession of the organization. 
Instances of syncope and death from fear are not of unfrequent oc- 
currence, and furnish a good exemplification of the direct debilitating 
influence of the depressing passions. The influence of grief and re- 
morse also, unnerves the vigour of the vital powers, and undermines 
the healthy play of the functions. The heart grows sick with care, 
and under the wasting agency of sorrow and despair, the natural 
plumpness of health shrinks and withers, and its bloom and freshness 
fade and vanish. All these causes act somewhat differently, yQ.t all 
are instrumental in developing similar results. Those of a physical 
character exercise their influence by debilitating some poi^tion of the 
living organism, which, from its sympathies, tends to involve other 
portions in the same condition with itself; while those v/hich are 
purely mental, seem first to enfeeble the brain, and to extend their 
influence from thence through the spinal centre and the ganglionic 
nerves, to the different systems and apparatus over which they pre- 
side. 

To the causes of debility which have been enumerated, must be 
added the condition which has been called by some pathologists ane- 
mia, or that state of the system which has been characterized bv a 
paucity of blood. When this deficiency has been occasioned by the 
artificial abstraction or accidental loss of the vital fluid, its debilitat- 
ing influence is well known. But although this form of anemia very 
naturally falls under this division of our subject, it is not our inten- 
tion to consider it here, as its effects are so palpable as to require no 
illustration. The form of anemia to which we wish to have special 



326 Geddings on Debility. 



reference, is that which proceeds from some change taking place m 
the process of sanguification, or in the organic structures by which 
the blood is elaborated and distributed to the elements of our tissues. 
It may be very justly alleged, that the anemia is, under these cir- 
cumstances, consecutive upon preexisting debility, and that it is the 
consequence and not the cause of that condition. But although this 
is true, as regards the state of that portion of the organization which 
is in immediate fault in occasioning the anemia, yet it is not altoge- 
ther correct when applied to the parts which may sufter from the de- 
fective or deteriorated circulation through them; for, as the blood is 
an essential stimulus for the living organism, it necessarily follows, 
that whenever its supply is defective, or its qualities deteriorated, 
the portions of the organization which are brought under the influ- 
ence of this defective supply, or this imperfectly animalized blood, 
must be enfeebled in a direct ratio with the extent of its privation. 
It is a well-known fact, that when the supply of blood is entirely 
cut off by the application of a ligature, the muscles are speedily seiz- 
ed with paralysis. Whatever, therefore, diminishes the supply of 
blood, whether it be imperfect sanguification, a diminution of the ca- 
libre of the vessel, a protracted metastasis of the fluid to some other 
point, or a mechanical impediment to its course, will always debili- 
tate the structure or organ which is exposed to the influence of such 
cause. A somewhat interesting case of debility complicated with, 
and probably dependant upon, a general state of anemia, fell under 
our observation. The individual was a maniac, and had been in that 
condition for several years, before we became acquainted with the 
circumstances of his case. With the exception of his mental aliena- 
tion, he had generally enjoyed good, though not robust health. Dur- 
ing the period that he and many others labouring under the same 
malady were objects of our care, his general health began gradually 
to decline. He was observed to grow pallid and inactive; his muscu- 
lar strength gradually declined, and at length became almost extinct; 
his bowels were torpid; his appetite capricious, though generally he 
eat the diet that was allowed him. A general inactivity and sluggish- 
ness seemed to seize upon all his functions, without our being able, 
on the most careful examination, to fix upon any particular organ as 
constituting the source of the manifest decline of the vital powers. 
His diet was improved; he was submitted to a course of alterative 
and tonic medicines, yet the asthenia continued to progress with a 
regular pace. His whole aspect became exsanguined; the borders of 
his lips presented the appearance of one who had suffered a profuse 
loss of blood; his muscles became gradually so feeble as to be unable 



1 



Geddings on Debility, 327 

to sustain the weight of the body, and he was consequently compel- 
led to remain in the recumbent or sitting posture. His bodily powers 
continuing thus to decline, his faculty of articulating became enfee- 
bled in a proportionate degree, and he finally sunk under the gene- 
ral debility which had taken possession of his organs. On examina- 
tion after death, the whole of the tissues, with the exception of the 
muscular, seemed to be almost entirely deprived of blood, or pre- 
sented the appearance of having been bleached. The arteries and 
veins were for the most part empty and colourless, and the small 
portion of blood which had circulated in them, was nearly all collect- 
ed about the right side of the heart. The muscles retained their na- 
tural colour, which contrasted very strongly with the blanched as- 
pect of the other tissues. The brain was unusually white, and was 
considerably indurated throughout its whole extent — so much so, 
that it could be rudely cut and handled without being torn or other- 
wise much injured in its texture. The liver was apparently in a 
healthy state; the gall-bladder contained the usual quantity of bile; 
but the bowels, and especially the stomach, presented a diameter al- 
together unusual. The latter, especially when isolated from the bodv 
and cautiously inflated, without using more force than was applied to 
two other adult stomachs similarly treated at the same time, assumed 
a volume at least double that to which they could be distended. The 
distention was equable at every point, and seemed to be attended 
with an attenuation of the tunics of the organ, which were bloodless 
and remarkably transparent. 

The circumstances of this case are important in several respects, 
and naturally suggest the question, whether the anemia was the con- 
sequence of the induration of the nervous centre, and the cause of 
the depression of the vital forces? or whether the induration of the 
brain was the immediate cause of the loss of power, without the ane- 
mia having any participation in its development.^ We are inclined to 
adopt the former opinion, which, indeed, seems to be supported both 
by reason and analogy. It is well known that perfect hssmatosis or 
sanguification, exacts a due and regular supply of nervous influence, 
and that whatever diminishes or cuts off the influence of innervation, 
diminishes or suspends that process. The texture of the brain, there- 
fore, having been altered and rendered more compact in its arrange- 
ment, than was consistent with the regular exercise of its functions, and 
the influence of this derangement being reflected, as it were, into the 
system of ganglionic nerves, which preside over and regulate all the 
molecular compositions and decompositions of all our solids and fluids, 
the natural harmony of these changes were of course disturbed or in- 

No. XVIII.—Feb. 18S2. 29 



328 Geddings on Debility, 

terruptedi the process of chylification was therefore imperfectly per- 
formed; that fluid could not be duly animalized, and was not submit- 
ted to those changes by which it is transformed into blood. In con- 
sequence, therefore, of the operation of these causes, a sufficient 
quantity of blood was not elaborated to excite and maintain the 
healthy play of the organism; it of course became enfeebled in pro- 
portion to the privation, and the train of phenomena were developed 
which exhibited themselves in the progress of the case. But it -may 
be urged, in objection to this conclusion, that the induration of the 
cerebral mass was sufficient of itself, independently of the anemia, 
to produce the loss of power manifested by the individual. This we 
are willing to admit might have been the case, yet we are disposed 
to doubt the validity of such a conclusion; for it often happens that 
the brain is as much or even more indurated than it was in this in- 
stance, without giving rise to any remarkable depression of the powers 
of life. Besides, the anemia could scarcely be attributable to any 
other cause than that which we have assigned; and as the known ef- 
fects of a diminution of the quantity of the blood, or a deterioration 
of its qualities, are to enfeeble the organism, we think we are war- 
ranted in giving the preference to the conclusion which we have 
adopted. 

Many cases of extreme debility, and even death, proceeding from 
anemia, might be enumerated, and especially those which occurred 
amongst the workers of the coal mines of Auzain and Dunkirk, as 
described by Chaussier; but we deem it unnecessary to multiply ex- 
amples, inasmuch as what has been already said will, we trust, be 
suf&cient to illustrate the principle in question. 

But debility may be also produced by an alteration in the quality, 
as well as in the quantity, of the blood. Whatever tends, therefore, 
to deteriorate its properties — to render it less nutritious, less ca- 
pable of stimulating and sustaining the organization, or endows it 
with qualities inimical to the healthy exercise of the functions, may 
depress or enfeeble the powers of life. This is observable in those 
cases in which the process of hsematosis is so imperfectly performed 
that the blood is deficient in red globules, has not its usual propor- 
tion of fibrinous particles, and is thin, pale, and watery. We not 
unfrequently meet with individuals whose blood is in this state; and 
in some instances we have seen it so thin and watery, as not to ex- 
hibit a deeper hue than very weak claret and water. This is often 
the case in some of the hydropic affections, and is doubtless owing to 
some change, or morbid condition, of the apparatus of sanguification. 
But whatever its cause may be, its natural and inevitable consequence 



Geddings on Debility. 329 

will be, to debilitate the organization, either by not being capable of 
furnishing the tissues with a requisite supply of nutritive molecules, 
or of exciting and maintai